{
"description": "This value set provides Claim Adjudication Decision codes.",
"_filename": "CodeSystem-claim-decision.json",
"package_name": "hl7.fhir.r5.core",
"date": null,
"meta": {
"profile": [ "http://hl7.org/fhir/StructureDefinition/shareablecodesystem" ],
"lastUpdated": "2022-09-10T04:52:37.223+10:00"
},
"publisher": null,
"content": "complete",
"name": "ClaimAdjudicationDecisionCodes",
"copyright": "HL7 Inc.",
"type": null,
"experimental": "false",
"resourceType": "CodeSystem",
"title": "Claim Adjudication Decision Codes",
"package_version": "5.0.0-ballot",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fm"
} ],
"status": "draft",
"id": "91dda30e-4213-471b-bd6c-b261292b9f9a",
"kind": null,
"url": "http://hl7.org/fhir/claim-decision",
"identifier": [ {
"value": "urn:oid:2.16.840.1.113883.4.642.4.1896",
"system": "urn:ietf:rfc:3986"
} ],
"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."
} ],
"caseSensitive": true,
"version": "5.0.0-ballot"
}