{
  "resourceType": "CodeSystem",
  "id": "claim-decision",
  "meta": {
    "lastUpdated": "2026-06-14T21:56:23.705+00:00"
  },
  "text": {
    "status": "generated",
    "div": "\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003e\u003cp class\u003d\"res-header-id\"\u003e\u003cb\u003eGenerated Narrative: CodeSystem claim-decision\u003c/b\u003e\u003c/p\u003e\u003ca name\u003d\"claim-decision\"\u003e \u003c/a\u003e\u003ca name\u003d\"hcclaim-decision\"\u003e \u003c/a\u003e\u003cp\u003eThis case-sensitive code system \u003ccode\u003ehttp://hl7.org/fhir/claim-decision\u003c/code\u003e defines the following codes:\u003c/p\u003e\u003ctable class\u003d\"codes\"\u003e\u003ctr\u003e\u003ctd style\u003d\"white-space:nowrap\"\u003e\u003cb\u003eCode\u003c/b\u003e\u003c/td\u003e\u003ctd\u003e\u003cb\u003eDisplay\u003c/b\u003e\u003c/td\u003e\u003ctd\u003e\u003cb\u003eDefinition\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"white-space:nowrap\"\u003edenied\u003ca name\u003d\"claim-decision-denied\"\u003e \u003c/a\u003e\u003c/td\u003e\u003ctd\u003eDenied\u003c/td\u003e\u003ctd\u003eThe claim, or individual services, are not approved for any payment. This may also be known as \u0027rejected\u0027.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"white-space:nowrap\"\u003eapproved\u003ca name\u003d\"claim-decision-approved\"\u003e \u003c/a\u003e\u003c/td\u003e\u003ctd\u003eApproved\u003c/td\u003e\u003ctd\u003eThe claim, or individual services, are approved as submitted.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"white-space:nowrap\"\u003epartial\u003ca name\u003d\"claim-decision-partial\"\u003e \u003c/a\u003e\u003c/td\u003e\u003ctd\u003ePartial\u003c/td\u003e\u003ctd\u003eThe claim, or individual services, are approved at an amount less than as submitted.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd style\u003d\"white-space:nowrap\"\u003epending\u003ca name\u003d\"claim-decision-pending\"\u003e \u003c/a\u003e\u003c/td\u003e\u003ctd\u003ePending\u003c/td\u003e\u003ctd\u003eThe adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.\u003c/td\u003e\u003c/tr\u003e\u003c/table\u003e\u003c/div\u003e"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fm"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "normative"
    }
  ],
  "url": "http://hl7.org/fhir/claim-decision",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.4.1896"
    }
  ],
  "version": "6.0.0-ballot4",
  "name": "ClaimAdjudicationDecisionCodes",
  "title": "Claim Adjudication Decision Codes",
  "status": "active",
  "experimental": false,
  "publisher": "HL7 International",
  "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 \u0027rejected\u0027."
    },
    {
      "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."
    }
  ]
}