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

## 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:

- ClaimDecisionReasonCodes

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

Code | Display | Definition
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.