Definition for Code SystemClaimAdjudicationDecisionCodes

{
  "resourceType" : "CodeSystem",
  "id" : "claim-decision",
  "meta" : {
    "lastUpdated" : "2024-11-20T21:23:48.918+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-decision</b></p><a name=\"claim-decision\"> </a><a name=\"hcclaim-decision\"> </a><a name=\"claim-decision-en-US\"> </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>"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "fm"
  }],
  "url" : "http://hl7.org/fhir/claim-decision",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.4.1896"
  }],
  "version" : "6.0.0-ballot2",
  "name" : "ClaimAdjudicationDecisionCodes",
  "title" : "Claim Adjudication Decision Codes",
  "status" : "active",
  "experimental" : false,
  "publisher" : "HL7 International",
  "description" : "This value set provides Claim Adjudication Decision 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" : "denied",
    "display" : "Denied",
    "definition" : "The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'."
  },
  {
    "code" : "approved",
    "display" : "Approved",
    "definition" : "The claim, or individual services, are approved as submitted."
  },
  {
    "code" : "partial",
    "display" : "Partial",
    "definition" : "The claim, or individual services, are approved at an amount less than as submitted."
  },
  {
    "code" : "pending",
    "display" : "Pending",
    "definition" : "The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information."
  }]
}