Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.3 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.3 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.3) 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: 0.4.3 | |||
| Draft as of 2025-10-30 | Computable Name: ClaimDecisionReasonCodes | |||
Codes for claim decision reasons
References
https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs
Expansion performed internally based on codesystem Claim Decision Reason Code System v0.4.3 (CodeSystem)
This value set contains 5 concepts
| Code | System | Display | Definition |
| 0001 | https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | Not medically necessary | The payer has determined this product, service, or procedure as not medically necessary. |
| 0002 | https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | Prior authorization not obtained | Prior authorization was not obtained prior to providing the product, service, or procedure. |
| 0003 | https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | Provider out-of-network | This provider is considered out-of-network by the payer for this plan. |
| 0004 | https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | Service inconsistent with patient age | The payer has determined this product, service, or procedure is not consistent with the patient's age. |
| 0005 | https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs | Benefit limits exceeded | The patient or subscriber benefit's have been exceeded. |
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 |