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This page is part of the Continuous Integration Build of FHIR Specification (v5.0.0: R5 - STU ). This is the current published version in it's permanent home (it will always (will be available incorrect/inconsistent at this URL). For a full list of available versions, see times).
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4.4.1.416 4.4.1.94 ValueSet http://hl7.org/fhir/ValueSet/claim-decision

  Maturity Level : 1
Responsible Owner: Financial Management icon Work Group Draft Normative Use Context : Country: World, Not Intended for Production use World
Official URL : http://hl7.org/fhir/ValueSet/claim-decision Version : 5.0.0 6.0.0-ballot3
draft active as of 2023-03-26 2025-11-14 Computable Name : ClaimAdjudicationDecisionsCodes
Flags : Experimental OID : 2.16.840.1.113883.4.642.3.2983

This value set is used in the following places:

4.4.1.416.1 4.4.1.94.1 Definition

This value set includes Claim Adjudication Decision codes.

4.4.1.416.2 4.4.1.94.2 Content Logical Definition

Generated Narrative: ValueSet claim-decision

Last updated: 2025-11-14T20:54:02.388Z

 

4.4.1.416.3 4.4.1.94.3 Expansion

This expansion generated 26 Mar 2023 14 Nov 2025

This value set contains 4 concepts

ValueSet

Expansion performed internally based on codesystem Claim Adjudication Decision Codes v5.0.0 v6.0.0-ballot3 (CodeSystem)

This value set contains 4 concepts

http://hl7.org/fhir/claim-decision http://hl7.org/fhir/claim-decision http://hl7.org/fhir/claim-decision http://hl7.org/fhir/claim-decision
Code System System Code Display Definition
http://hl7.org/fhir/claim-decision    denied Denied The claim, or individual services, are not approved for any payment. This may also be known as 'rejected'.
http://hl7.org/fhir/claim-decision    approved Approved The claim, or individual services, are approved as submitted.
http://hl7.org/fhir/claim-decision    partial Partial The claim, or individual services, are approved at an amount less than as submitted.
http://hl7.org/fhir/claim-decision    pending Pending The adjudication processing is not complete. This may be due to requiring manual review or receipt of additional information.

 

See the full registry of value sets defined as part of FHIR.

Explanation of the columns that may appear on this page:

Lvl A few code lists that FHIR defines are hierarchical - each code is assigned a level. For value sets, levels are mostly used to organize codes for user convenience, but may follow code system hierarchy - 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