HL7 Terminology (THO)
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This page is part of the HL7 Terminology (v6.0.1: Release) based on FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: overallClaimDisposition - JSON Representation

Active as of 2019-12-01

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{
  "resourceType" : "CodeSystem",
  "id" : "v2-0457",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem v2-0457</b></p><a name=\"v2-0457\"> </a><a name=\"hcv2-0457\"> </a><a name=\"v2-0457-en-US\"> </a><p><b>Properties</b></p><p><b>This code system defines the following properties for its concepts</b></p><table class=\"grid\"><tr><td><b>Name</b></td><td><b>Code</b></td><td><b>URI</b></td><td><b>Type</b></td><td><b>Description</b></td></tr><tr><td>status</td><td>status</td><td>http://terminology.hl7.org/CodeSystem/utg-concept-properties#status</td><td>code</td><td>Status of the concept</td></tr><tr><td>deprecated</td><td>deprecated</td><td>http://terminology.hl7.org/CodeSystem/utg-concept-properties#v2-table-deprecated</td><td>code</td><td>Version of HL7 in which the code was deprecated</td></tr></table><p><b>Concepts</b></p><p>This case-sensitive code system <code>http://terminology.hl7.org/CodeSystem/v2-0457</code> defines the following codes in a Is-A hierarchy:</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\">0<a name=\"v2-0457-0\"> </a></td><td>No edits present on claim</td><td>No edits present on claim</td></tr><tr><td style=\"white-space:nowrap\">1<a name=\"v2-0457-1\"> </a></td><td>Only edits present are for line item denial or rejection</td><td>Only edits present are for line item denial or rejection</td></tr><tr><td style=\"white-space:nowrap\">2<a name=\"v2-0457-2\"> </a></td><td>Multiple-day claim with one or more days denied or rejected</td><td>Multiple-day claim with one or more days denied or rejected</td></tr><tr><td style=\"white-space:nowrap\">3<a name=\"v2-0457-3\"> </a></td><td>Claim denied, rejected, suspended or returned to provider with only post payment edits</td><td>Claim denied, rejected, suspended or returned to provider with only post payment edits</td></tr><tr><td style=\"white-space:nowrap\">4<a name=\"v2-0457-4\"> </a></td><td>Claim denied, rejected, suspended or returned to provider with only pre payment edits</td><td>Claim denied, rejected, suspended or returned to provider with only pre payment edits</td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "fm"
    }
  ],
  "url" : "http://terminology.hl7.org/CodeSystem/v2-0457",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.18.292"
    }
  ],
  "version" : "2.0.0",
  "name" : "OverallClaimDisposition",
  "title" : "overallClaimDisposition",
  "status" : "active",
  "experimental" : false,
  "date" : "2019-12-01",
  "publisher" : "Health Level Seven International",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://hl7.org"
        },
        {
          "system" : "email",
          "value" : "hq@HL7.org"
        }
      ]
    }
  ],
  "description" : "Code system of concepts specifying the final status of the claim.  Used in HL7 Version 2.x messaging in the GP1 segment.",
  "purpose" : "Underlying Master Code System for V2 table 0457 (Overall Claim Disposition Code)",
  "copyright" : "This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html",
  "caseSensitive" : true,
  "valueSet" : "http://terminology.hl7.org/ValueSet/v2-0457",
  "hierarchyMeaning" : "is-a",
  "compositional" : false,
  "versionNeeded" : false,
  "content" : "complete",
  "property" : [
    {
      "code" : "status",
      "uri" : "http://terminology.hl7.org/CodeSystem/utg-concept-properties#status",
      "description" : "Status of the concept",
      "type" : "code"
    },
    {
      "code" : "deprecated",
      "uri" : "http://terminology.hl7.org/CodeSystem/utg-concept-properties#v2-table-deprecated",
      "description" : "Version of HL7 in which the code was deprecated",
      "type" : "code"
    }
  ],
  "concept" : [
    {
      "id" : "4832",
      "code" : "0",
      "display" : "No edits present on claim",
      "definition" : "No edits present on claim",
      "property" : [
        {
          "code" : "status",
          "valueCode" : "A"
        }
      ]
    },
    {
      "id" : "4833",
      "code" : "1",
      "display" : "Only edits present are for line item denial or rejection",
      "definition" : "Only edits present are for line item denial or rejection",
      "property" : [
        {
          "code" : "status",
          "valueCode" : "A"
        }
      ]
    },
    {
      "id" : "4834",
      "code" : "2",
      "display" : "Multiple-day claim with one or more days denied or rejected",
      "definition" : "Multiple-day claim with one or more days denied or rejected",
      "property" : [
        {
          "code" : "status",
          "valueCode" : "A"
        }
      ]
    },
    {
      "id" : "4835",
      "code" : "3",
      "display" : "Claim denied, rejected, suspended or returned to provider with only post payment edits",
      "definition" : "Claim denied, rejected, suspended or returned to provider with only post payment edits",
      "property" : [
        {
          "code" : "status",
          "valueCode" : "A"
        }
      ]
    },
    {
      "id" : "4836",
      "code" : "4",
      "display" : "Claim denied, rejected, suspended or returned to provider with only pre payment edits",
      "definition" : "Claim denied, rejected, suspended or returned to provider with only pre payment edits",
      "property" : [
        {
          "code" : "status",
          "valueCode" : "A"
        }
      ]
    }
  ]
}