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

## ValueSet: Claim Decision Reason Codes

Official URL: https://fhir-ig.digital.health.nz/shared-care/ValueSet/claim-decision-reason-codes | Version: 0.4.5
Draft as of 2026-03-03 | Computable Name: ClaimDecisionReasonCodes

Codes for claim decision reasons

References

- Shared Care Review Outcome

### Logical Definition (CLD)

- Include all codes defined in `https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs`

### Expansion

Expansion performed internally based on codesystem Claim Decision Reason Code System v0.4.5 (CodeSystem)

This value set contains 31 concepts

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

Explanation of the columns that may appear on this page:

Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System | 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)
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