HL7 Terminology (THO)
7.3.0 - Publication International flag

This page is part of the HL7 Terminology (v7.3.0: Release) based on FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions

: Claim Adjudication Basis Categories

Active as of 2026-06-12 Maturity Level: 1

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="claim-adjudication-basis-categories"/>
  <meta>
    <lastUpdated value="2026-06-12T00:00:00+00:00"/>
    <profile
             value="http://hl7.org/fhir/StructureDefinition/shareablevalueset"/>
  </meta>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ValueSet claim-adjudication-basis-categories</b></p><a name="claim-adjudication-basis-categories"> </a><a name="hcclaim-adjudication-basis-categories"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Last updated: 2026-06-12 00:00:00+0000</p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/R5/shareablevalueset.html">Shareable ValueSet</a></p></div><ul><li>Include all codes defined in <a href="CodeSystem-claim-adjudication-basis-categories.html"><code>http://terminology.hl7.org/CodeSystem/claim-adjudication-basis-categories</code></a><span title="Version is not explicitly stated, which means it is fixed to the version provided in this specification"> version &#x1F4E6;1.0.0</span></li></ul></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="1"/>
  </extension>
  <url
       value="http://terminology.hl7.org/ValueSet/claim-adjudication-basis-categories"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.11.21041"/>
  </identifier>
  <version value="1.0.0"/>
  <name value="ClaimAdjudicationBasisCategories"/>
  <title value="Claim Adjudication Basis Categories"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2026-06-12T00:00:00+00:00"/>
  <publisher value="Health Level Seven International"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://hl7.org"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="hq@HL7.org"/>
    </telecom>
  </contact>
  <description
               value="Categories of contractual, policy, benefit, or administrative bases used by a payer when adjudicating a healthcare claim and determining the allowed, paid, or adjusted amounts. These codes include categories that describe why a claim line or claim total was adjudicated as it was, rather than the result of the adjudication."/>
  <copyright
             value="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"/>
  <compose>
    <include>
      <system
              value="http://terminology.hl7.org/CodeSystem/claim-adjudication-basis-categories"/>
    </include>
  </compose>
</ValueSet>