Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.5 - release New Zealand flag

Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.5) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

CodeSystem: Claim Decision Reason Code System

Official URL: https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs Version: 0.4.5
Draft as of 2026-03-03 Computable Name: ClaimDecisionReasonCS

Code system for claim decision reasons based on validation rule IDs

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs defines the following codes:

CodeDisplayDefinition
DET040.014 Passed A valid claim date has been provided.
DET040.015 Failed Claim date provided is not valid.
DET052.001 Passed No duplicate found for this claim
DET052.002 Failed Claim is a duplicate of claim [Claim Number] received on [Received Date].
DET001.006 Passed Agreement is valid for {service name} services
DET001.001 Failed Agreement number provided cannot be found in our records
DET001.007 Failed Agreement is not valid for {service name} services
DET063.003 Passed Provider HPI organisation is appropriate for the Agreement
DET063.004 Failed Provider HPI organisation is not appropriate for the Agreement
DET055.001 Passed NHI number found in our records.
DET055.002 Failed NHI number cannot be found in our records.
DET055.004 Passed NHI number validation passes for health service user.
DET055.018 Passed Patient is eligible for subsidised healthcare
DET055.019 Failed Patient is not eligible for subsidised healthcare
DET041.088 Passed Date of Service is earlier than or equal to Claim Date.
DET041.087 Failed Date of Service is later than Claim Date.
DET020.003 Passed Date of Service falls between Agreement start and end date.
DET020.002 Failed Date of Service did not occur between the Agreement start and termination dates.
DET064.001 Passed Record of encounter was found in our system.
DET064.002 Failed Could not find the encounter with identifier {identifier} in our system.
DET064.003 Passed Encounter is for the same Patient as the Claim.
DET064.004 Failed Encounter and Claim do not refer to the same Patient.
DET064.005 Passed Encounter is for the same Service Date as the Claim Item.
DET064.006 Failed Encounter and Claim Item have different Service Dates.
DET064.007 Passed Patient attended the Encounter.
DET064.008 Failed Cannot claim for an Encounter that did not occur.
DET064.009 Passed Encounter is only claimed once.
DET064.010 Failed Encounter cannot be claimed more than once.
DET055.005 Failed NHI number provided is for a deceased health service user.
DET064.011 Passed Fee(s) found for purchase unit code and contracted service.
DET064.012 Passed Purchase unit code not valid for this contracted service - no fee(s) found.