Claim Adjudication Decision Reason Codes
draftURL
http://hl7.org/fhir/ValueSet/claim-decision-reason
Version5.0.0
PublisherFHIR Project teamDescriptionThis value set includes example Claim Adjudication Decision Reason codes.
Expansion
| Code | Display | System |
|---|---|---|
| 0001 | Not medically necessary | http://hl7.org/fhir/claim-decision-reason |
| 0002 | Prior authorization not obtained | http://hl7.org/fhir/claim-decision-reason |
| 0003 | Provider out-of-network | http://hl7.org/fhir/claim-decision-reason |
| 0004 | Service inconsistent with patient age | http://hl7.org/fhir/claim-decision-reason |
| 0005 | Benefit limits exceeded | http://hl7.org/fhir/claim-decision-reason |