Definition for Code SystemClaimAdjudicationDecisionCodes

<?xml version="1.0" encoding="UTF-8"?>

<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="claim-decision"/> 
  <meta> 
    <lastUpdated value="2024-11-20T21:23:48.918+00:00"/> 
    <profile value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/> 
  </meta> 
  <text> 
    <status value="generated"/> 
    <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> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/> 
  </extension> 
  <url value="http://hl7.org/fhir/claim-decision"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.4.1896"/> 
  </identifier> 
  <version value="6.0.0-ballot2"/> 
  <name value="ClaimAdjudicationDecisionCodes"/> 
  <title value="Claim Adjudication Decision Codes"/> 
  <status value="active"/> 
  <experimental value="false"/> 
  <publisher value="HL7 International"/> 
  <description value="This value set provides Claim Adjudication Decision codes."/> 
  <jurisdiction> 
    <coding> 
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/> 
      <code value="001"/> 
      <display value="World"/> 
    </coding> 
  </jurisdiction> 
  <copyright value="HL7 Inc."/> 
  <caseSensitive value="true"/> 
  <content value="complete"/> 
  <concept> 
    <code value="denied"/> 
    <display value="Denied"/> 
    <definition value="The claim, or individual services, are not approved for any payment. This may also
     be known as 'rejected'."/> 
  </concept> 
  <concept> 
    <code value="approved"/> 
    <display value="Approved"/> 
    <definition value="The claim, or individual services, are approved as submitted."/> 
  </concept> 
  <concept> 
    <code value="partial"/> 
    <display value="Partial"/> 
    <definition value="The claim, or individual services, are approved at an amount less than as submitted."/> 
  </concept> 
  <concept> 
    <code value="pending"/> 
    <display value="Pending"/> 
    <definition value="The adjudication processing is not complete. This may be due to requiring manual
     review or receipt of additional information."/> 
  </concept> 
</CodeSystem>