<?xml version="1.0" encoding="UTF-8"?>

<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="claim-decision"/>
  <meta>
    <lastUpdated value="2026-04-01T17:59:15.240+00:00"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      <p class="res-header-id">
        <b>Generated Narrative: CodeSystem claim-decision</b>
      </p>
      <a name="claim-decision"> </a>
      <a name="hcclaim-decision"> </a>
      <p>This case-sensitive code system 
        <code>http://hl7.org/fhir/claim-decision</code> defines the following codes:
      </p>
      <table class="codes">
        <tr>
          <td style="white-space:nowrap">
            <b>Code</b>
          </td>
          <td>
            <b>Display</b>
          </td>
          <td>
            <b>Definition</b>
          </td>
        </tr>
        <tr>
          <td style="white-space:nowrap">denied
            <a name="claim-decision-denied"> </a>
          </td>
          <td>Denied</td>
          <td>The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.</td>
        </tr>
        <tr>
          <td style="white-space:nowrap">approved
            <a name="claim-decision-approved"> </a>
          </td>
          <td>Approved</td>
          <td>The claim, or individual services, are approved as submitted.</td>
        </tr>
        <tr>
          <td style="white-space:nowrap">partial
            <a name="claim-decision-partial"> </a>
          </td>
          <td>Partial</td>
          <td>The claim, or individual services, are approved at an amount less than as submitted.</td>
        </tr>
        <tr>
          <td style="white-space:nowrap">pending
            <a name="claim-decision-pending"> </a>
          </td>
          <td>Pending</td>
          <td>The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.</td>
        </tr>
      </table>
    </div>
  </text>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="normative"/>
  </extension>
  <url value="http://hl7.org/fhir/claim-decision"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.4.1896"/>
  </identifier>
  <version value="6.0.0-ballot4"/>
  <name value="ClaimAdjudicationDecisionCodes"/>
  <title value="Claim Adjudication Decision Codes"/>
  <status value="active"/>
  <experimental value="false"/>
  <publisher value="HL7 International"/>
  <description value="This value set provides Claim Adjudication Decision codes."/>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </coding>
  </jurisdiction>
  <copyright value="HL7 Inc."/>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <concept>
    <code value="denied"/>
    <display value="Denied"/>
    <definition value="The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'."/>
  </concept>
  <concept>
    <code value="approved"/>
    <display value="Approved"/>
    <definition value="The claim, or individual services, are approved as submitted."/>
  </concept>
  <concept>
    <code value="partial"/>
    <display value="Partial"/>
    <definition value="The claim, or individual services, are approved at an amount less than as submitted."/>
  </concept>
  <concept>
    <code value="pending"/>
    <display value="Pending"/>
    <definition value="The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information."/>
  </concept>
</CodeSystem>