Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.5 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.5 - release
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
| Draft as of 2026-03-03 |
<CodeSystem xmlns="http://hl7.org/fhir">
<id value="claim-decision-reason-cs"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem claim-decision-reason-cs</b></p><a name="claim-decision-reason-cs"> </a><a name="hcclaim-decision-reason-cs"> </a><p>This case-sensitive code system <code>https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs</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">DET040.014<a name="claim-decision-reason-cs-DET040.46014"> </a></td><td>Passed</td><td>A valid claim date has been provided.</td></tr><tr><td style="white-space:nowrap">DET040.015<a name="claim-decision-reason-cs-DET040.46015"> </a></td><td>Failed</td><td>Claim date provided is not valid.</td></tr><tr><td style="white-space:nowrap">DET052.001<a name="claim-decision-reason-cs-DET052.46001"> </a></td><td>Passed</td><td>No duplicate found for this claim</td></tr><tr><td style="white-space:nowrap">DET052.002<a name="claim-decision-reason-cs-DET052.46002"> </a></td><td>Failed</td><td>Claim is a duplicate of claim [Claim Number] received on [Received Date].</td></tr><tr><td style="white-space:nowrap">DET001.006<a name="claim-decision-reason-cs-DET001.46006"> </a></td><td>Passed</td><td>Agreement is valid for {service name} services</td></tr><tr><td style="white-space:nowrap">DET001.001<a name="claim-decision-reason-cs-DET001.46001"> </a></td><td>Failed</td><td>Agreement number provided cannot be found in our records</td></tr><tr><td style="white-space:nowrap">DET001.007<a name="claim-decision-reason-cs-DET001.46007"> </a></td><td>Failed</td><td>Agreement is not valid for {service name} services</td></tr><tr><td style="white-space:nowrap">DET063.003<a name="claim-decision-reason-cs-DET063.46003"> </a></td><td>Passed</td><td>Provider HPI organisation is appropriate for the Agreement</td></tr><tr><td style="white-space:nowrap">DET063.004<a name="claim-decision-reason-cs-DET063.46004"> </a></td><td>Failed</td><td>Provider HPI organisation is not appropriate for the Agreement</td></tr><tr><td style="white-space:nowrap">DET055.001<a name="claim-decision-reason-cs-DET055.46001"> </a></td><td>Passed</td><td>NHI number found in our records.</td></tr><tr><td style="white-space:nowrap">DET055.002<a name="claim-decision-reason-cs-DET055.46002"> </a></td><td>Failed</td><td>NHI number cannot be found in our records.</td></tr><tr><td style="white-space:nowrap">DET055.004<a name="claim-decision-reason-cs-DET055.46004"> </a></td><td>Passed</td><td>NHI number validation passes for health service user.</td></tr><tr><td style="white-space:nowrap">DET055.018<a name="claim-decision-reason-cs-DET055.46018"> </a></td><td>Passed</td><td>Patient is eligible for subsidised healthcare</td></tr><tr><td style="white-space:nowrap">DET055.019<a name="claim-decision-reason-cs-DET055.46019"> </a></td><td>Failed</td><td>Patient is not eligible for subsidised healthcare</td></tr><tr><td style="white-space:nowrap">DET041.088<a name="claim-decision-reason-cs-DET041.46088"> </a></td><td>Passed</td><td>Date of Service is earlier than or equal to Claim Date.</td></tr><tr><td style="white-space:nowrap">DET041.087<a name="claim-decision-reason-cs-DET041.46087"> </a></td><td>Failed</td><td>Date of Service is later than Claim Date.</td></tr><tr><td style="white-space:nowrap">DET020.003<a name="claim-decision-reason-cs-DET020.46003"> </a></td><td>Passed</td><td>Date of Service falls between Agreement start and end date.</td></tr><tr><td style="white-space:nowrap">DET020.002<a name="claim-decision-reason-cs-DET020.46002"> </a></td><td>Failed</td><td>Date of Service did not occur between the Agreement start and termination dates.</td></tr><tr><td style="white-space:nowrap">DET064.001<a name="claim-decision-reason-cs-DET064.46001"> </a></td><td>Passed</td><td>Record of encounter was found in our system.</td></tr><tr><td style="white-space:nowrap">DET064.002<a name="claim-decision-reason-cs-DET064.46002"> </a></td><td>Failed</td><td>Could not find the encounter with identifier {identifier} in our system.</td></tr><tr><td style="white-space:nowrap">DET064.003<a name="claim-decision-reason-cs-DET064.46003"> </a></td><td>Passed</td><td>Encounter is for the same Patient as the Claim.</td></tr><tr><td style="white-space:nowrap">DET064.004<a name="claim-decision-reason-cs-DET064.46004"> </a></td><td>Failed</td><td>Encounter and Claim do not refer to the same Patient.</td></tr><tr><td style="white-space:nowrap">DET064.005<a name="claim-decision-reason-cs-DET064.46005"> </a></td><td>Passed</td><td>Encounter is for the same Service Date as the Claim Item.</td></tr><tr><td style="white-space:nowrap">DET064.006<a name="claim-decision-reason-cs-DET064.46006"> </a></td><td>Failed</td><td>Encounter and Claim Item have different Service Dates.</td></tr><tr><td style="white-space:nowrap">DET064.007<a name="claim-decision-reason-cs-DET064.46007"> </a></td><td>Passed</td><td>Patient attended the Encounter.</td></tr><tr><td style="white-space:nowrap">DET064.008<a name="claim-decision-reason-cs-DET064.46008"> </a></td><td>Failed</td><td>Cannot claim for an Encounter that did not occur.</td></tr><tr><td style="white-space:nowrap">DET064.009<a name="claim-decision-reason-cs-DET064.46009"> </a></td><td>Passed</td><td>Encounter is only claimed once.</td></tr><tr><td style="white-space:nowrap">DET064.010<a name="claim-decision-reason-cs-DET064.46010"> </a></td><td>Failed</td><td>Encounter cannot be claimed more than once.</td></tr><tr><td style="white-space:nowrap">DET055.005<a name="claim-decision-reason-cs-DET055.46005"> </a></td><td>Failed</td><td>NHI number provided is for a deceased health service user.</td></tr><tr><td style="white-space:nowrap">DET064.011<a name="claim-decision-reason-cs-DET064.46011"> </a></td><td>Passed</td><td>Fee(s) found for purchase unit code and contracted service.</td></tr><tr><td style="white-space:nowrap">DET064.012<a name="claim-decision-reason-cs-DET064.46012"> </a></td><td>Passed</td><td>Purchase unit code not valid for this contracted service - no fee(s) found.</td></tr></table></div>
</text>
<url
value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs"/>
<version value="0.4.5"/>
<name value="ClaimDecisionReasonCS"/>
<title value="Claim Decision Reason Code System"/>
<status value="draft"/>
<date value="2026-03-03T21:51:04+00:00"/>
<publisher value="Te Whatu Ora"/>
<contact>
<name value="Te Whatu Ora"/>
<telecom>
<system value="url"/>
<value value="https://www.tewhatuora.govt.nz/"/>
</telecom>
</contact>
<contact>
<name value="Te Whatu Ora Integration Team"/>
<telecom>
<system value="email"/>
<value value="integration@tewhatuora.govt.nz"/>
<use value="work"/>
</telecom>
</contact>
<description
value="Code system for claim decision reasons based on validation rule IDs"/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="NZ"/>
<display value="New Zealand"/>
</coding>
</jurisdiction>
<caseSensitive value="true"/>
<content value="complete"/>
<count value="31"/>
<concept>
<code value="DET040.014"/>
<display value="Passed"/>
<definition value="A valid claim date has been provided."/>
</concept>
<concept>
<code value="DET040.015"/>
<display value="Failed"/>
<definition value="Claim date provided is not valid."/>
</concept>
<concept>
<code value="DET052.001"/>
<display value="Passed"/>
<definition value="No duplicate found for this claim"/>
</concept>
<concept>
<code value="DET052.002"/>
<display value="Failed"/>
<definition
value="Claim is a duplicate of claim [Claim Number] received on [Received Date]."/>
</concept>
<concept>
<code value="DET001.006"/>
<display value="Passed"/>
<definition value="Agreement is valid for {service name} services"/>
</concept>
<concept>
<code value="DET001.001"/>
<display value="Failed"/>
<definition
value="Agreement number provided cannot be found in our records"/>
</concept>
<concept>
<code value="DET001.007"/>
<display value="Failed"/>
<definition value="Agreement is not valid for {service name} services"/>
</concept>
<concept>
<code value="DET063.003"/>
<display value="Passed"/>
<definition
value="Provider HPI organisation is appropriate for the Agreement"/>
</concept>
<concept>
<code value="DET063.004"/>
<display value="Failed"/>
<definition
value="Provider HPI organisation is not appropriate for the Agreement"/>
</concept>
<concept>
<code value="DET055.001"/>
<display value="Passed"/>
<definition value="NHI number found in our records."/>
</concept>
<concept>
<code value="DET055.002"/>
<display value="Failed"/>
<definition value="NHI number cannot be found in our records."/>
</concept>
<concept>
<code value="DET055.004"/>
<display value="Passed"/>
<definition
value="NHI number validation passes for health service user."/>
</concept>
<concept>
<code value="DET055.018"/>
<display value="Passed"/>
<definition value="Patient is eligible for subsidised healthcare"/>
</concept>
<concept>
<code value="DET055.019"/>
<display value="Failed"/>
<definition value="Patient is not eligible for subsidised healthcare"/>
</concept>
<concept>
<code value="DET041.088"/>
<display value="Passed"/>
<definition
value="Date of Service is earlier than or equal to Claim Date."/>
</concept>
<concept>
<code value="DET041.087"/>
<display value="Failed"/>
<definition value="Date of Service is later than Claim Date."/>
</concept>
<concept>
<code value="DET020.003"/>
<display value="Passed"/>
<definition
value="Date of Service falls between Agreement start and end date."/>
</concept>
<concept>
<code value="DET020.002"/>
<display value="Failed"/>
<definition
value="Date of Service did not occur between the Agreement start and termination dates."/>
</concept>
<concept>
<code value="DET064.001"/>
<display value="Passed"/>
<definition value="Record of encounter was found in our system."/>
</concept>
<concept>
<code value="DET064.002"/>
<display value="Failed"/>
<definition
value="Could not find the encounter with identifier {identifier} in our system."/>
</concept>
<concept>
<code value="DET064.003"/>
<display value="Passed"/>
<definition value="Encounter is for the same Patient as the Claim."/>
</concept>
<concept>
<code value="DET064.004"/>
<display value="Failed"/>
<definition
value="Encounter and Claim do not refer to the same Patient."/>
</concept>
<concept>
<code value="DET064.005"/>
<display value="Passed"/>
<definition
value="Encounter is for the same Service Date as the Claim Item."/>
</concept>
<concept>
<code value="DET064.006"/>
<display value="Failed"/>
<definition
value="Encounter and Claim Item have different Service Dates."/>
</concept>
<concept>
<code value="DET064.007"/>
<display value="Passed"/>
<definition value="Patient attended the Encounter."/>
</concept>
<concept>
<code value="DET064.008"/>
<display value="Failed"/>
<definition value="Cannot claim for an Encounter that did not occur."/>
</concept>
<concept>
<code value="DET064.009"/>
<display value="Passed"/>
<definition value="Encounter is only claimed once."/>
</concept>
<concept>
<code value="DET064.010"/>
<display value="Failed"/>
<definition value="Encounter cannot be claimed more than once."/>
</concept>
<concept>
<code value="DET055.005"/>
<display value="Failed"/>
<definition
value="NHI number provided is for a deceased health service user."/>
</concept>
<concept>
<code value="DET064.011"/>
<display value="Passed"/>
<definition
value="Fee(s) found for purchase unit code and contracted service."/>
</concept>
<concept>
<code value="DET064.012"/>
<display value="Passed"/>
<definition
value="Purchase unit code not valid for this contracted service - no fee(s) found."/>
</concept>
</CodeSystem>