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4.4.1.435 ValueSet http://hl7.org/fhir/ValueSet/claim-decision

Financial Management icon Work Group  Maturity Level: 1 Draft Use Context: Country: World, Not Intended for Production use
Official URL: http://hl7.org/fhir/ValueSet/claim-decision Version: 6.0.0-ballot2
draft as of 2024-11-22 Computable Name: ClaimAdjudicationDecisionsCodes
Flags: Experimental OID: 2.16.840.1.113883.4.642.3.2983

This value set is used in the following places:

4.4.1.435.1 Definition

This value set includes Claim Adjudication Decision codes.

4.4.1.435.2 Content Logical Definition

Generated Narrative: ValueSet claim-decision

Last updated: 2024-11-22T13:35:32.968Z

Profile: Shareable ValueSet

 

4.4.1.435.3 Expansion

This expansion generated 22 Nov 2024

Generated Narrative: ValueSet

Last updated: 2024-11-22T13:35:32.968Z

Profile: Shareable ValueSet

Expansion based on codesystem Claim Adjudication Decision Codes v6.0.0-ballot2 (CodeSystem)

This value set contains 4 concepts

CodeSystemDisplayDefinition
  denied http://hl7.org/fhir/claim-decision Denied

The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.

  approved http://hl7.org/fhir/claim-decision Approved

The claim, or individual services, are approved as submitted.

  partial http://hl7.org/fhir/claim-decision Partial

The claim, or individual services, are approved at an amount less than as submitted.

  pending http://hl7.org/fhir/claim-decision Pending

The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.

 

See the full registry of value sets defined as part of FHIR.

Explanation of the columns that may appear on this page:

Lvl A few code lists that FHIR defines are hierarchical - each code is assigned a level. For value sets, levels are mostly used to organize codes for user convenience, but may follow code system hierarchy - see Code System for further information
Source The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance). If the code is in italics, this indicates that the code is not selectable ('Abstract')
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code