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4.4.1.639 ValueSet http://hl7.org/fhir/ValueSet/claim-decision-reason

Financial Management icon Work Group  Maturity Level: 1 Draft Use Context: Country: World
Official URL: http://hl7.org/fhir/ValueSet/claim-decision-reason Version: 6.0.0-ballot3
draft as of 2025-10-13 Computable Name: ClaimAdjudicationDecisionReasonCodes
Flags: OID: 2.16.840.1.113883.4.642.3.3338

This value set is used in the following places:

4.4.1.639.1 Definition

This value set includes example Claim Adjudication Decision Reason codes.

4.4.1.639.2 Content Logical Definition

Generated Narrative: ValueSet claim-decision-reason

Last updated: 2025-10-13T15:54:10.839Z

Profile: Shareable ValueSet

 

4.4.1.639.3 Expansion

This expansion generated 13 Oct 2025

ValueSet

Expansion performed internally based on codesystem Claim Adjudication Decision Reason Codes v6.0.0-ballot3 (CodeSystem)

This value set contains 5 concepts

SystemCodeDisplay
http://hl7.org/fhir/claim-decision-reason   0001 Not medically necessary
http://hl7.org/fhir/claim-decision-reason   0002 Prior authorization not obtained
http://hl7.org/fhir/claim-decision-reason   0003 Provider out-of-network
http://hl7.org/fhir/claim-decision-reason   0004 Service inconsistent with patient age
http://hl7.org/fhir/claim-decision-reason   0005 Benefit limits exceeded

 

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