{"caseSensitive":true,"concept":[{"code":"denied","definition":"The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.","display":"Denied"},{"code":"approved","definition":"The claim, or individual services, are approved as submitted.","display":"Approved"},{"code":"partial","definition":"The claim, or individual services, are approved at an amount less than as submitted.","display":"Partial"},{"code":"pending","definition":"The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.","display":"Pending"}],"content":"complete","copyright":"HL7 Inc.","description":"This value set provides Claim Adjudication Decision codes.","experimental":false,"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-wg","valueCode":"fm"},{"url":"http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status","valueCode":"normative"}],"id":"claim-decision","identifier":[{"system":"urn:ietf:rfc:3986","value":"urn:oid:2.16.840.1.113883.4.642.4.1896"}],"jurisdiction":[{"coding":[{"code":"001","display":"World","system":"http://unstats.un.org/unsd/methods/m49/m49.htm"}]}],"meta":{"lastUpdated":"2026-04-03T20:06:10.198+00:00"},"name":"ClaimAdjudicationDecisionCodes","publisher":"HL7 International","resourceType":"CodeSystem","status":"active","text":{"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><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>","status":"generated"},"title":"Claim Adjudication Decision Codes","url":"http://hl7.org/fhir/claim-decision","version":"6.0.0-ballot4"}