ClaimAdjudicationDecisionCodes

Claim Adjudication Decision Codes

activeExtensions for Using Data Elements from FHIR R5 in FHIR R40.1.0complete4 concepts

This value set provides Claim Adjudication Decision codes.

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/claim-decision
ID
claim-decision
Version
5.0.0
Publisher
Financial Management
Case Sensitive
Yes

Concepts (4)

CodeDisplayDefinition
deniedDeniedThe claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.
approvedApprovedThe claim, or individual services, are approved as submitted.
partialPartialThe claim, or individual services, are approved at an amount less than as submitted.
pendingPendingThe adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.