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
| Official URL: https://fhir-ig.digital.health.nz/shared-care/ValueSet/claim-decision-reason-codes | Version: 0.4.5 | |||
| Draft as of 2026-07-20 | Computable Name: ClaimDecisionReasonCodes | |||
Codes for claim decision reasons
References
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs version 📦0.4.5
Expansion performed internally based on codesystem Claim Decision Reason Code System v0.4.5 (CodeSystem)
This value set contains 40 concepts
| System | Code | Display (en) | Definition | JSON | XML |
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET040.014 | Passed | A valid claim date has been provided. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET040.015 | Failed | Claim date provided is not valid. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET052.001 | Passed | No duplicate found for this claim | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET052.002 | Failed | Claim is a duplicate of claim [Claim Number] received on [Received Date]. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET001.006 | Passed | Agreement is valid for {service name} services | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET001.001 | Failed | Agreement number provided cannot be found in our records | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET001.007 | Failed | Agreement is not valid for {service name} services | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET063.003 | Passed | Provider HPI organisation is appropriate for the Agreement | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET063.004 | Failed | Provider HPI organisation is not appropriate for the Agreement | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET055.001 | Passed | NHI number found in our records. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET055.002 | Failed | NHI number cannot be found in our records. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET055.004 | Passed | NHI number validation passes for health service user. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET055.018 | Passed | Patient is eligible for subsidised healthcare | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET055.019 | Failed | Patient is not eligible for subsidised healthcare | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET041.088 | Passed | Date of Service is earlier than or equal to Claim Date. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET041.087 | Failed | Date of Service is later than Claim Date. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET020.003 | Passed | Date of Service falls between Agreement start and end date. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET020.002 | Failed | Date of Service did not occur between the Agreement start and termination dates. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.001 | Passed | Record of encounter was found in our system. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.002 | Failed | Could not find the encounter with identifier {identifier} in our system. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.003 | Passed | Encounter is for the same Patient as the Claim. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.004 | Failed | Encounter and Claim do not refer to the same Patient. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.005 | Passed | Encounter is for the same Service Date as the Claim Item. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.006 | Failed | Encounter and Claim Item have different Service Dates. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.007 | Passed | Patient attended the Encounter. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.008 | Failed | Cannot claim for an Encounter that did not occur. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.009 | Passed | Encounter is only claimed once. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.010 | Failed | Encounter cannot be claimed more than once. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET055.005 | Failed | NHI number provided is for a deceased health service user. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.011 | Passed | Fee(s) found for purchase unit code and contracted service. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.012 | Passed | Purchase unit code not valid for this contracted service - no fee(s) found. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.013 | Passed | Claimed fee {feeCode} is valid for the patient's age. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.014 | Failed | Patient's age was older than maximum allowed age for claimed fee {feeCode}. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.015 | Failed | Patient's age was younger than minimum allowed age for claimed fee {feeCode}. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.016 | Passed | Claimed fee {feeCode} is valid for consultation date & time. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.017 | Failed | Patient's consultation occurred outside of time period for claimed fee {feeCode}. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.018 | Passed | Claimed fee {feeCode} is valid for patient's CSC status. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.019 | Failed | Patient's CSC status does not correspond to the claimed fee {feeCode}. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.020 | Passed | Fee(s) found for product code and contracted service. | ||
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | DET064.021 | Failed | Product 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 |