http://hl7.org/fhir/claim-decision-reason
Latest: null
| name | ClaimAdjudicationDecisionReasonCodes | |
| description | This value set provides example Claim Adjudication Decision Reason codes. | |
| content | complete | |
| status | active |
Diagnostics
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| code | display | definition | |
| 0001 | Not medically necessary | The payer has determined this product, service, or procedure as not medically necessary. | |
| 0002 | Prior authorization not obtained | Prior authorization was not obtained prior to providing the product, service, or procedure. | |
| 0003 | Provider out-of-network | This provider is considered out-of-network by the payer for this plan. | |
| 0004 | Service inconsistent with patient age | The payer has determined this product, service, or procedure is not consistent with the patient's age. | |
| 0005 | Benefit limits exceeded | The patient or subscriber benefit's have been exceeded. |