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Packagehl7.fhir.uv.xver-r5.r4b
Resource TypeCodeSystem
IdCodeSystem-claim-decision.json
FHIR VersionR4B
Sourcehttp://hl7.org/fhir/uv/xver-r5.r4b/0.0.1-snapshot-2/CodeSystem-claim-decision.html
URLhttp://hl7.org/fhir/claim-decision
Version5.0.0
Statusactive
Date2025-09-13T17:27:08-04:00
NameClaimAdjudicationDecisionCodes
TitleClaim Adjudication Decision Codes
Realmuv
Authorityhl7
DescriptionThis value set provides Claim Adjudication Decision codes.
CopyrightHL7 Inc.
Contentcomplete

Resources that use this resource

ValueSet
R5-claim-decision-for-R4BCross-version VS for R5.ClaimAdjudicationDecisionsCodes for use in FHIR R4B
R5-claim-decision-for-R4Cross-version VS for R5.ClaimAdjudicationDecisionsCodes for use in FHIR R4

Resources that this resource uses

No resources found

Narrative

Note: links and images are rebased to the (stated) source

This code system http://hl7.org/fhir/claim-decision defines the following codes:

Code Display Definition
denied Denied The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.
approved Approved The claim, or individual services, are approved as submitted.
partial Partial The claim, or individual services, are approved at an amount less than as submitted.
pending Pending The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.

Source1

{
  "resourceType": "CodeSystem",
  "id": "claim-decision",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "extension": [
        {
          "url": "packageId",
          "valueId": "hl7.fhir.uv.xver-r5.r4b"
        },
        {
          "url": "version",
          "valueString": "0.0.1-snapshot-2"
        }
      ],
      "url": "http://hl7.org/fhir/StructureDefinition/package-source"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fm"
    }
  ],
  "url": "http://hl7.org/fhir/claim-decision",
  "version": "5.0.0",
  "name": "ClaimAdjudicationDecisionCodes",
  "title": "Claim Adjudication Decision Codes",
  "status": "active",
  "experimental": false,
  "date": "2025-09-13T17:27:08-04:00",
  "publisher": "Financial Management",
  "contact": [
    {
      "name": "Financial Management",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/fm"
        }
      ]
    }
  ],
  "description": "This value set provides Claim Adjudication Decision codes.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code": "001",
          "display": "World"
        }
      ]
    }
  ],
  "copyright": "HL7 Inc.",
  "caseSensitive": true,
  "content": "complete",
  "concept": [
    {
      "code": "denied",
      "display": "Denied",
      "definition": "The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'."
    },
    {
      "code": "approved",
      "display": "Approved",
      "definition": "The claim, or individual services, are approved as submitted."
    },
    {
      "code": "partial",
      "display": "Partial",
      "definition": "The claim, or individual services, are approved at an amount less than as submitted."
    },
    {
      "code": "pending",
      "display": "Pending",
      "definition": "The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information."
    }
  ]
}