R6 Ballot (3rd Draft) FHIR CI-Build

This page is part of the FHIR Specification v6.0.0-ballot3: Release 6 Ballot (3rd Draft) (see Ballot Notes ). The current version is 5.0.0 . For a full list Continuous Integration Build of available versions, see FHIR (will be incorrect/inconsistent at times).
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4.3.2.218 4.3.2.203 CodeSystem http://hl7.org/fhir/claim-decision

Responsible Owner: Financial Management icon Work Group   Maturity Level : 0 Informative Use Context : Country: World
Official URL : http://hl7.org/fhir/claim-decision Version : 6.0.0-ballot3
active as of 2025-04-01 2025-11-10 Computable Name : ClaimAdjudicationDecisionCodes
Flags : CaseSensitive, Complete OID : 2.16.840.1.113883.4.642.4.1896

"This Code system is used in the following FHIR core-defined or referenced value sets:

4.3.2.218.1 4.3.2.203.1 Definition

This value set provides Claim Adjudication Decision codes.

4.3.2.218.2 4.3.2.203.2 Content

Generated Narrative: CodeSystem claim-decision

Last updated: 2025-04-01T12:16:37.966+11:00 Profile: Shareable CodeSystem 2025-11-10T04:50:58.407Z

This case-sensitive code system http://hl7.org/fhir/claim-decision defines the following codes:

Code Display Definition Copy
denied Denied The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'. btn   btn
approved Approved The claim, or individual services, are approved as submitted. btn   btn
partial Partial The claim, or individual services, are approved at an amount less than as submitted. btn   btn
pending Pending The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information. btn   btn

 

See the full registry of code systems defined as part of FHIR.

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. See Code System for further information.
Source The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance). If the code is in italics, this indicates that the code is not selectable ('Abstract')
Display The display (used in the display element of a Coding ). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code