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Financial Management Work Group | Maturity Level: N/A | Standards Status: Informative |
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Definition for Code SystemClaimAdjudicationDecisionCodes
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- <http://hl7.org/fhir/CodeSystem/claim-decision> a fhir:CodeSystem ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "claim-decision"] ; # fhir:meta [ fhir:lastUpdated [ fhir:v "2025-03-18T13:49:06.036+00:00"^^xsd:dateTime ] ; fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/shareablecodesystem"^^xsd:anyURI ; fhir:link <http://hl7.org/fhir/StructureDefinition/shareablecodesystem> ] ) ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "<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><a name=\"claim-decision-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"shareablecodesystem.html\">Shareable CodeSystem</a></p></div><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>"^^rdf:XMLLiteral ] ; # fhir:extension ( [ fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ; fhir:value [ a fhir:code ; fhir:v "fm" ] ] ) ; # fhir:url [ fhir:v "http://hl7.org/fhir/claim-decision"^^xsd:anyURI] ; # fhir:identifier ( [ fhir:system [ fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ] ; fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.4.1896" ] ] ) ; # fhir:version [ fhir:v "6.0.0-ballot2"] ; # fhir:name [ fhir:v "ClaimAdjudicationDecisionCodes"] ; # fhir:title [ fhir:v "Claim Adjudication Decision Codes"] ; # fhir:status [ fhir:v "active"] ; # fhir:experimental [ fhir:v false] ; # fhir:publisher [ fhir:v "HL7 International"] ; # fhir:description [ fhir:v "This value set provides Claim Adjudication Decision codes."] ; # fhir:jurisdiction ( [ fhir:coding ( [ fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm"^^xsd:anyURI ] ; fhir:code [ fhir:v "001" ] ; fhir:display [ fhir:v "World" ] ] ) ] ) ; # fhir:copyright [ fhir:v "HL7 Inc."] ; # fhir:caseSensitive [ fhir:v true] ; # fhir:hierarchyMeaning [] ; # fhir:content [ fhir:v "complete"] ; # fhir:concept ( [ fhir:code [ fhir:v "denied" ] ; fhir:display [ fhir:v "Denied" ] ; fhir:definition [ fhir:v "The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'." ] ] [ fhir:code [ fhir:v "approved" ] ; fhir:display [ fhir:v "Approved" ] ; fhir:definition [ fhir:v "The claim, or individual services, are approved as submitted." ] ] [ fhir:code [ fhir:v "partial" ] ; fhir:display [ fhir:v "Partial" ] ; fhir:definition [ fhir:v "The claim, or individual services, are approved at an amount less than as submitted." ] ] [ fhir:code [ fhir:v "pending" ] ; fhir:display [ fhir:v "Pending" ] ; fhir:definition [ fhir:v "The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information." ] ] ) . # # -------------------------------------------------------------------------------------
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.
FHIR ®© HL7.org 2011+. FHIR R6 hl7.fhir.core#6.0.0-ballot2 generated on Tue, Mar 18, 2025 13:55+0000.
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