Definition
for
Code
SystemClaimAdjudicationDecisionCodes
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
[] a fhir:CodeSystem ;
fhir:id [ fhir:v "claim-decision"] ;
<http://hl7.org/fhir/CodeSystem/claim-decision> a fhir:CodeSystem ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "claim-decision"] ; #
fhir:meta [
fhir:lastUpdated [ fhir:v "2023-03-26T15:21:02.749+11:00" ] ;
fhir:profile ( [ fhir:v "http://hl7.org/fhir/StructureDefinition/shareablecodesystem" ] )
] ;
fhir:lastUpdated [ fhir:v "2025-11-10T15:17:08.817+00:00"^^xsd:dateTime ]
] ; #
fhir:text [
fhir:status [ fhir:v "generated" ]
] ;
fhir:status [ fhir:v "generated" ] ;
fhir:div [ fhir:v "<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><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>"^^rdf:XMLLiteral ]
] ; #
fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg" ] ;
fhir:value [ fhir:v "fm" ]
] ) ;
fhir:url [ fhir:v "http://hl7.org/fhir/claim-decision"], [ fhir:v "http://hl7.org/fhir/claim-decision"] ;
fhir:url [
fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ;
fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-wg>
] ;
fhir:value [
a fhir:Code ;
fhir:v "fm"
]
] ) ; #
fhir:url [
fhir:v "http://hl7.org/fhir/claim-decision"^^xsd:anyURI ;
fhir:l <http://hl7.org/fhir/claim-decision>
] ; #
fhir:identifier ( [
fhir:system [ fhir:v "urn:ietf:rfc:3986" ] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.4.1896" ]
] [
fhir:system [ fhir:v "urn:ietf:rfc:3986" ] ;
fhir:system [
fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ;
fhir:l <urn:ietf:rfc:3986>
] ;
fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.4.1896" ]
] ) ;
fhir:version [ fhir:v "5.0.0"], [ fhir:v "5.0.0"] ;
fhir:name [ fhir:v "ClaimAdjudicationDecisionCodes"], [ fhir:v "ClaimAdjudicationDecisionCodes"] ;
fhir:title [ fhir:v "Claim Adjudication Decision Codes"], [ fhir:v "Claim Adjudication Decision Codes"] ;
fhir:status [ fhir:v "active"], [ fhir:v "active"] ;
fhir:experimental [ fhir:v "false"], [ fhir:v "false"] ;
fhir:publisher [ fhir:v "HL7 International"], [ fhir:v "HL7 International"] ;
fhir:description [ fhir:v "This value set provides Claim Adjudication Decision codes."], [ fhir:v "This value set provides Claim Adjudication Decision codes."] ;
] ) ; #
fhir:version [ fhir:v "6.0.0-ballot3"] ; #
fhir:name [ fhir:v "ClaimAdjudicationDecisionCodes"] ; #
fhir:title [ fhir:v "Claim Adjudication Decision Codes"] ; #
fhir:status [ fhir:v "active"] ; #
fhir:experimental [ fhir:v false] ; #
fhir:publisher [ fhir:v "HL7 International"] ; #
fhir:description [ fhir:v "This value set provides Claim Adjudication Decision codes."] ; #
fhir:jurisdiction ( [
fhir:coding ( [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm" ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]
] )
] [
fhir:coding ( [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm" ] ;
fhir:system [
fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm"^^xsd:anyURI ;
fhir:l <http://unstats.un.org/unsd/methods/m49/m49.htm>
] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]
] )
] ) ;
fhir:copyright [ fhir:v "HL7 Inc."], [ fhir:v "HL7 Inc."] ;
fhir:caseSensitive [ fhir:v "true"] ;
fhir:content [ fhir:v "complete"] ;
] ) ; #
fhir:copyright [ fhir:v "HL7 Inc."] ; #
fhir:caseSensitive [ fhir:v true] ; #
fhir:hierarchyMeaning [] ; #
fhir:content [ fhir:v "complete"] ; #
fhir:concept ( [
fhir:code [ fhir:v "denied" ] ;
fhir:display [ fhir:v "Denied" ] ;
fhir:definition [ fhir:v "The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'." ]
] [
fhir:code [ fhir:v "approved" ] ;
fhir:display [ fhir:v "Approved" ] ;
fhir:definition [ fhir:v "The claim, or individual services, are approved as submitted." ]
] [
fhir:code [ fhir:v "partial" ] ;
fhir:display [ fhir:v "Partial" ] ;
fhir:definition [ fhir:v "The claim, or individual services, are approved at an amount less than as submitted." ]
] [
fhir:code [ fhir:v "pending" ] ;
fhir:display [ fhir:v "Pending" ] ;
fhir:definition [ fhir:v "The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information." ]
] ) .
] ) . #
# -------------------------------------------------------------------------------------
Usage
note:
every
effort
has
been
made
to
ensure
that
the
examples
are
correct
and
useful,
but
they
are
not
a
normative
part
of
the
specification.
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