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Example CodeSystem/claim-outcome (JSON)

Financial Management Work GroupMaturity Level: N/AStandards Status: Informative

Raw JSON (canonical form + also see JSON Format Specification)

Definition for Code SystemClaimProcessingOutcomeCodes

{
  "resourceType" : "CodeSystem",
  "id" : "claim-outcome",
  "meta" : {
    "lastUpdated" : "2024-11-12T02:57:08.856+00:00",
    "profile" : ["http://hl7.org/fhir/StructureDefinition/shareablecodesystem"]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem claim-outcome</b></p><a name=\"claim-outcome\"> </a><a name=\"hcclaim-outcome\"> </a><a name=\"claim-outcome-en-US\"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/claim-outcome</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\">queued<a name=\"claim-outcome-queued\"> </a></td><td>Queued</td><td>The Claim/Pre-authorization/Pre-determination has been received but processing has not begun.</td></tr><tr><td style=\"white-space:nowrap\">complete<a name=\"claim-outcome-complete\"> </a></td><td>Processing Complete</td><td>The processing has completed without errors</td></tr><tr><td style=\"white-space:nowrap\">error<a name=\"claim-outcome-error\"> </a></td><td>Error</td><td>One or more errors have been detected in the Claim</td></tr><tr><td style=\"white-space:nowrap\">partial<a name=\"claim-outcome-partial\"> </a></td><td>Partial Processing</td><td>No errors have been detected in the Claim and some of the adjudication has been performed.</td></tr></table></div>"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "fm"
  }],
  "url" : "http://hl7.org/fhir/claim-outcome",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.4.1897"
  }],
  "version" : "6.0.0-ballot2",
  "name" : "ClaimProcessingOutcomeCodes",
  "title" : "Claim Processing Outcome Codes",
  "status" : "active",
  "experimental" : false,
  "publisher" : "HL7 International",
  "description" : "This value set includes Claim Processing Outcome 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" : "queued",
    "display" : "Queued",
    "definition" : "The Claim/Pre-authorization/Pre-determination has been received but processing has not begun."
  },
  {
    "code" : "complete",
    "display" : "Processing Complete",
    "definition" : "The processing has completed without errors"
  },
  {
    "code" : "error",
    "display" : "Error",
    "definition" : "One or more errors have been detected in the Claim"
  },
  {
    "code" : "partial",
    "display" : "Partial Processing",
    "definition" : "No errors have been detected in the Claim and some of the adjudication has been performed."
  }]
}

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.