Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.2 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.2 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.2) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Draft as of 2025-09-24 |
{
"resourceType" : "CodeSystem",
"id" : "claim-decision-reason-cs",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem claim-decision-reason-cs</b></p><a name=\"claim-decision-reason-cs\"> </a><a name=\"hcclaim-decision-reason-cs\"> </a><p>This case-sensitive code system <code>https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">0001<a name=\"claim-decision-reason-cs-0001\"> </a></td><td>Not medically necessary</td><td>The payer has determined this product, service, or procedure as not medically necessary.</td></tr><tr><td style=\"white-space:nowrap\">0002<a name=\"claim-decision-reason-cs-0002\"> </a></td><td>Prior authorization not obtained</td><td>Prior authorization was not obtained prior to providing the product, service, or procedure.</td></tr><tr><td style=\"white-space:nowrap\">0003<a name=\"claim-decision-reason-cs-0003\"> </a></td><td>Provider out-of-network</td><td>This provider is considered out-of-network by the payer for this plan.</td></tr><tr><td style=\"white-space:nowrap\">0004<a name=\"claim-decision-reason-cs-0004\"> </a></td><td>Service inconsistent with patient age</td><td>The payer has determined this product, service, or procedure is not consistent with the patient's age.</td></tr><tr><td style=\"white-space:nowrap\">0005<a name=\"claim-decision-reason-cs-0005\"> </a></td><td>Benefit limits exceeded</td><td>The patient or subscriber benefit's have been exceeded.</td></tr></table></div>"
},
"url" : "https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs",
"version" : "0.4.2",
"name" : "ClaimDecisionReasonCS",
"title" : "Claim Decision Reason Code System",
"status" : "draft",
"date" : "2025-09-24T02:45:27+00:00",
"publisher" : "Te Whatu Ora",
"contact" : [
{
"name" : "Te Whatu Ora",
"telecom" : [
{
"system" : "url",
"value" : "https://www.tewhatuora.govt.nz/"
}
]
},
{
"name" : "Te Whatu Ora Integration Team",
"telecom" : [
{
"system" : "email",
"value" : "integration@tewhatuora.govt.nz",
"use" : "work"
}
]
}
],
"description" : "Code system for claim decision reasons based on FHIR R5 claim-decision-reason",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "NZ",
"display" : "New Zealand"
}
]
}
],
"caseSensitive" : true,
"content" : "complete",
"count" : 5,
"concept" : [
{
"code" : "0001",
"display" : "Not medically necessary",
"definition" : "The payer has determined this product, service, or procedure as not medically necessary."
},
{
"code" : "0002",
"display" : "Prior authorization not obtained",
"definition" : "Prior authorization was not obtained prior to providing the product, service, or procedure."
},
{
"code" : "0003",
"display" : "Provider out-of-network",
"definition" : "This provider is considered out-of-network by the payer for this plan."
},
{
"code" : "0004",
"display" : "Service inconsistent with patient age",
"definition" : "The payer has determined this product, service, or procedure is not consistent with the patient's age."
},
{
"code" : "0005",
"display" : "Benefit limits exceeded",
"definition" : "The patient or subscriber benefit's have been exceeded."
}
]
}