Healthcare Financial Services IG Edition 1
0.3.0 - ci-build Saudi Arabia flag

Healthcare Financial Services IG Edition 1 - Local Development build (v0.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

CodeSystem: Adjudication Error

Official URL: http://nphies.sa/terminology/CodeSystem/adjudication-error Version: 0.3.0
Active as of 2025-06-23 Computable Name: AdjudicationError

Copyright/Legal: nphies 2020+ (https://nphies.sa)

This code set includes a set of adjudication error codes which may be issued during the validation of a message.

This Code system is referenced in the content logical definition of the following value sets:

Generated Narrative: CodeSystem adjudication-error

version: 1; Last updated: 2020-11-11 17:23:48+0300

This case-sensitive code system http://nphies.sa/terminology/CodeSystem/adjudication-error provides a fragment that includes following codes:

CodeDisplay
1191 Missing element: [Patient] within the message
1190 Missing element: [Communication.note.text] within the message
1199 Missing element: [patient.birthDate] within the message
1198 Missing element: [gender.extensionKsaGender] within the message
1197 Missing element: [patient.gender ] within the message
1196 Missing element: [patient.name] within the message
1195 Missing element: [patient.active] within the message
1194 Missing element: [patient.identifier] within the message
1193 Missing element: [patient.id] within the message
260 Missing element: [Claim.careTeam.role] within the message
1192 Missing element: [patient.resourceType] within the message
760 Missing element: [Claim.insurance.coverage] within the message
761 Missing element: [Claim.insurance.preAuthRef] within the message
762 Missing element: [Claim.insurance.claimResponse] within the message
261 Missing element: [Claim.supportingInfo] within the message
763 Missing element: [Claim.accident] within the message
764 Missing element: [Claim.accident.Date] within the message
262 Missing element: [Claim.supportingInfo.sequence] within the message
765 Missing element: [Claim.accident.type] within the message
1133 Missing element: [ClaimResponse.processNote] within the message
263 Missing element: [Claim.supportingInfo.category] within the message
766 Missing element: [Claim.accident.locationAdress] within the message
264 Missing element: [Claim.supportingInfo.code] within the message
1625 ClaimResponse.item.detail.Sequence detailSequence in the claim response SHALL match item.detail.sequence within the claim.item
1132 Missing element: [ClaimResponse.fundsReserve] within the message
767 Missing element: [Claim.item] within the message
34 Missing element: [CoverageEligibilityResponse.patient] within the message
265 Missing element: [Claim.supportingInfo.timingDate] within the message
1189 Missing element: [Communication.note.time] within the message
1131 Missing element: [ClaimResponse.total.amount.currency] within the message
768 Missing element: [Claim.item.extension.tax] within the message
1130 Missing element: [ClaimResponse.total.amount.value] within the message
266 Missing element: [Claim.supportingInfo.timingPeriod] within the message
1624 ClaimResponse.item.detail.Sequence detailSequence in the claim response SHALL match item.detail.sequence within the claim.item
769 Missing element: [Claim.item.sequence] within the message
35 Missing element: [CoverageEligibilityResponse.servicedDate] within the message
770 Missing element: [Claim.item.careTeamSequence] within the message
267 Missing element: [Claim.supportingInfo.valueBoolean] within the message
1672 Services performed outside the coverage effective period
36 Missing element: [CoverageEligibilityResponse.created] within the message
268 Missing element: [Claim.supportingInfo.valueString] within the message
1177 Missing element: [Communication.subject] within the message
37 Missing element: [CoverageEligibilityResponse.request] within the message
269 Missing element: [Claim.supportingInfo.valueQuantity] within the message
1176 Missing element: [Communication.medium] within the message
12 Missing element: [entry.CoverageEligibilityRequest] within the message
1671 The requested medicine(s) is not registered
38 Missing element: [CoverageEligibilityResponse.outcome] within the message
1175 Missing element: [Communication.priority] within the message
270 Missing element: [Claim.supportingInfo.valueAttachment] within the message
340 Missing element: [Claim.fundsReserve] within the message
39 Missing element: [CoverageEligibilityResponse.disposition] within the message
1174 Missing element: [Communication.category] within the message
1670 Service code is inconsistent with the patient's gender
13 Missing element: [CoverageEligibilityRequest.resourceType] within the message
380 Missing element: [Claim.item.extension.tax] within the message
271 Missing element: [Claim.supportingInfo.valueReference] within the message
1669 Diagnosis is inconsistent with the patient's gender
14 Missing element: [CoverageEligibilityRequest.id] within the message
381 Missing element: [Claim.item.sequence] within the message
1668 Supporting information not related to the patient
272 Missing element: [Claim.supportingInfo.reason] within the message
382 Missing element: [Claim.item.careTeamSequence] within the message
1667 The service code is invalid given the patient history
1666 Provider not licensed during the date of service
273 Missing element: [Claim.diagnosis] within the message
1665 New born exceeds 30 days of age
274 Missing element: [Claim.diagnosis.sequence] within the message
1129 Missing element: [ClaimResponse.total.amount] within the message
1664 Policy is cancelled/expired
275 Missing element: [Claim.diagnosis.diagnosisCodeableConcept] within the message
1663 MEMBER DELETED
1662 Tooth number is missing
276 Missing element: [Claim.diagnosis.type] within the message
1682 The patient information does not match the insurance member details.
1128 Missing element: [ClaimResponse.total.category] within the message
320 Missing element: [Claim.item.detail.subDetail.unitPrice] within the message
277 Missing element: [Claim.insurance] within the message
1111 Missing element: [ClaimResponse.item.detail.noteNumber] within the message
1127 Missing element: [ClaimResponse.total] within the message
278 Missing element: [Claim.insurance.sequence] within the message
1126 Missing element: [ClaimResponse.item.detail.subDetail.adjudication.amount.currency] within the message
279 Missing element: [Claim.insurance.focal] within the message
1125 Missing element: [ClaimResponse.item.detail.subDetail.adjudication.amount.value] within the message
1595 Claim serviced SHALL be on OR after the creation date if the claim use=Authorization
56 Missing element: [Claim.status] within the message
700 Missing element: [Claim.item.detail.subDetail.sequence] within the message
57 Missing element: [Claim.type] within the message
1124 Missing element: [ClaimResponse.item.detail.subDetail.adjudication.amount] within the message
321 Missing element: [Claim.item.detail.subDetail.net] within the message
1110 Missing element: [ClaimResponse.item.detail.detailSequence] within the message
58 Missing element: [Claim.subType] within the message
701 Missing element: [Claim.item.detail.subDetail.productOrService] within the message
771 Missing element: [Claim.item.diagnosisSequence] within the message
59 Missing element: [Claim.use] within the message
1123 Missing element: [ClaimResponse.item.detail.subDetail.adjudication.reason] within the message
1594 Claim.billablePeriod SHALL be within the encounter start and end date if encounter is provided
322 Missing element: [Claim.item.detail.subDetail.udi] within the message
60 Missing element: [Claim.patient] within the message
1593 Claim.subType If Claim type is profesional ,then the Claim sub-type SHALL not be IP