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Source1

{
  "resourceType": "ValueSet",
  "id": "R5-claim-decision-reason-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-reason-for-R4",
  "version": "0.1.0",
  "name": "R5ClaimDecisionReasonForR4",
  "title": "Cross-version ValueSet R5.ClaimAdjudicationDecisionReasonCodes 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-reason|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-reason|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.item.reviewOutcome.reason`\n* `ExplanationOfBenefit.item.reviewOutcome.reason`\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-reason|5.0.0`, defined in FHIR R5 does not have any mapping to FHIR R4",
  "compose": {
    "include": [
      {
        "system": "http://hl7.org/fhir/claim-decision-reason",
        "version": "5.0.0",
        "concept": [
          {
            "code": "0001",
            "display": "Not medically necessary"
          },
          {
            "code": "0002",
            "display": "Prior authorization not obtained"
          },
          {
            "code": "0003",
            "display": "Provider out-of-network"
          },
          {
            "code": "0004",
            "display": "Service inconsistent with patient age"
          },
          {
            "code": "0005",
            "display": "Benefit limits exceeded"
          }
        ]
      }
    ]
  },
  "expansion": {
    "timestamp": "2026-03-17T21:02:03.8104715+00:00",
    "contains": [
      {
        "system": "http://hl7.org/fhir/claim-decision-reason",
        "version": "5.0.0",
        "code": "0001",
        "display": "Not medically necessary"
      },
      {
        "system": "http://hl7.org/fhir/claim-decision-reason",
        "version": "5.0.0",
        "code": "0002",
        "display": "Prior authorization not obtained"
      },
      {
        "system": "http://hl7.org/fhir/claim-decision-reason",
        "version": "5.0.0",
        "code": "0003",
        "display": "Provider out-of-network"
      },
      {
        "system": "http://hl7.org/fhir/claim-decision-reason",
        "version": "5.0.0",
        "code": "0004",
        "display": "Service inconsistent with patient age"
      },
      {
        "system": "http://hl7.org/fhir/claim-decision-reason",
        "version": "5.0.0",
        "code": "0005",
        "display": "Benefit limits exceeded"
      }
    ]
  }
}