FHIR IG analytics| Package | hl7.fhir.uv.xver-r5.r4 |
| Resource Type | ValueSet |
| Id | ValueSet-R5-claim-decision-for-R4.json |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/uv/xver-r5.r4/0.1.0/ValueSet-R5-claim-decision-for-R4.html |
| URL | http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-for-R4 |
| Version | 0.1.0 |
| Status | active |
| Date | 2026-03-17T21:02:03.8104715+00:00 |
| Name | R5ClaimDecisionForR4 |
| Title | Cross-version ValueSet R5.ClaimAdjudicationDecisionsCodes for use in FHIR R4 |
| Realm | uv |
| Authority | hl7 |
| Description | This cross-version ValueSet represents content from `http://hl7.org/fhir/ValueSet/claim-decision|5.0.0` for use in FHIR R4. |
| Purpose | This value set is part of the cross-version definitions generated to enable use of the value set `http://hl7.org/fhir/ValueSet/claim-decision|5.0.0` as defined in FHIR R5 in FHIR R4. The source value set is bound to the following FHIR R5 elements: * `ClaimResponse.decision` * `ClaimResponse.item.reviewOutcome.decision` * `ExplanationOfBenefit.decision` * `ExplanationOfBenefit.item.reviewOutcome.decision` Note that all concepts are included in this cross-version definition because no concepts have compatible representations Following are the generation technical comments: FHIR ValueSet `http://hl7.org/fhir/ValueSet/claim-decision|5.0.0`, defined in FHIR R5 does not have any mapping to FHIR R4 |
No resources found
| CodeSystem | ||
| hl7.fhir.uv.xver-r5.r4.r4#0.0.1-snapshot-2 | claim-decision | Claim Adjudication Decision Codes |
Note: links and images are rebased to the (stated) source
Generated Narrative: ValueSet R5-claim-decision-for-R4
This value set expansion contains 4 concepts.
| System | Version | Code | Display | Definition |
http://hl7.org/fhir/claim-decision | 5.0.0 | approved | Approved | The claim, or individual services, are approved as submitted. |
http://hl7.org/fhir/claim-decision | 5.0.0 | denied | Denied | The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'. |
http://hl7.org/fhir/claim-decision | 5.0.0 | partial | Partial | The claim, or individual services, are approved at an amount less than as submitted. |
http://hl7.org/fhir/claim-decision | 5.0.0 | pending | Pending | The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information. |
{
"resourceType": "ValueSet",
"id": "R5-claim-decision-for-R4",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fm"
},
{
"extension": [
{
"url": "packageId",
"valueId": "hl7.fhir.uv.xver-r5.r4"
},
{
"url": "version",
"valueString": "0.1.0"
},
{
"url": "uri",
"valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/package-source"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "trial-use",
"_valueCode": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"
}
]
}
}
],
"url": "http://hl7.org/fhir/uv/xver/ValueSet/R5-claim-decision-for-R4",
"version": "0.1.0",
"name": "R5ClaimDecisionForR4",
"title": "Cross-version ValueSet R5.ClaimAdjudicationDecisionsCodes for use in FHIR R4",
"status": "active",
"experimental": false,
"date": "2026-03-17T21:02:03.8104715+00:00",
"publisher": "Financial Management",
"contact": [
{
"name": "Financial Management",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fm"
}
]
}
],
"description": "This cross-version ValueSet represents content from `http://hl7.org/fhir/ValueSet/claim-decision|5.0.0` for use in FHIR R4.",
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"purpose": "This value set is part of the cross-version definitions generated to enable use of the\r\nvalue set `http://hl7.org/fhir/ValueSet/claim-decision|5.0.0` as defined in FHIR R5\r\nin FHIR R4.\r\n\r\nThe source value set is bound to the following FHIR R5 elements:\r\n* `ClaimResponse.decision`\n* `ClaimResponse.item.reviewOutcome.decision`\n* `ExplanationOfBenefit.decision`\n* `ExplanationOfBenefit.item.reviewOutcome.decision`\r\n\r\nNote that all concepts are included in this cross-version definition because no concepts have compatible representations\r\n\r\nFollowing are the generation technical comments:\r\n\nFHIR ValueSet `http://hl7.org/fhir/ValueSet/claim-decision|5.0.0`, defined in FHIR R5 does not have any mapping to FHIR R4",
"compose": {
"include": [
{
"system": "http://hl7.org/fhir/claim-decision",
"version": "5.0.0",
"concept": [
{
"code": "approved",
"display": "Approved"
},
{
"code": "denied",
"display": "Denied"
},
{
"code": "partial",
"display": "Partial"
},
{
"code": "pending",
"display": "Pending"
}
]
}
]
},
"expansion": {
"timestamp": "2026-03-17T21:02:03.8104715+00:00",
"contains": [
{
"system": "http://hl7.org/fhir/claim-decision",
"version": "5.0.0",
"code": "approved",
"display": "Approved"
},
{
"system": "http://hl7.org/fhir/claim-decision",
"version": "5.0.0",
"code": "denied",
"display": "Denied"
},
{
"system": "http://hl7.org/fhir/claim-decision",
"version": "5.0.0",
"code": "partial",
"display": "Partial"
},
{
"system": "http://hl7.org/fhir/claim-decision",
"version": "5.0.0",
"code": "pending",
"display": "Pending"
}
]
}
}