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 |
<CodeSystem xmlns="http://hl7.org/fhir">
<id value="claim-decision-reason-cs"/>
<text>
<status value="generated"/>
<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>
</text>
<url
value="https://fhir-ig.digital.health.nz/shared-care/CodeSystem/claim-decision-reason-cs"/>
<version value="0.4.2"/>
<name value="ClaimDecisionReasonCS"/>
<title value="Claim Decision Reason Code System"/>
<status value="draft"/>
<date value="2025-09-24T02:45:27+00:00"/>
<publisher value="Te Whatu Ora"/>
<contact>
<name value="Te Whatu Ora"/>
<telecom>
<system value="url"/>
<value value="https://www.tewhatuora.govt.nz/"/>
</telecom>
</contact>
<contact>
<name value="Te Whatu Ora Integration Team"/>
<telecom>
<system value="email"/>
<value value="integration@tewhatuora.govt.nz"/>
<use value="work"/>
</telecom>
</contact>
<description
value="Code system for claim decision reasons based on FHIR R5 claim-decision-reason"/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="NZ"/>
<display value="New Zealand"/>
</coding>
</jurisdiction>
<caseSensitive value="true"/>
<content value="complete"/>
<count value="5"/>
<concept>
<code value="0001"/>
<display value="Not medically necessary"/>
<definition
value="The payer has determined this product, service, or procedure as not medically necessary."/>
</concept>
<concept>
<code value="0002"/>
<display value="Prior authorization not obtained"/>
<definition
value="Prior authorization was not obtained prior to providing the product, service, or procedure."/>
</concept>
<concept>
<code value="0003"/>
<display value="Provider out-of-network"/>
<definition
value="This provider is considered out-of-network by the payer for this plan."/>
</concept>
<concept>
<code value="0004"/>
<display value="Service inconsistent with patient age"/>
<definition
value="The payer has determined this product, service, or procedure is not consistent with the patient's age."/>
</concept>
<concept>
<code value="0005"/>
<display value="Benefit limits exceeded"/>
<definition
value="The patient or subscriber benefit's have been exceeded."/>
</concept>
</CodeSystem>