@prefix fhir: . @prefix owl: . @prefix rdf: . @prefix rdfs: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:CodeSystem ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "adjudication-error"] ; # fhir:meta [ fhir:versionId [ fhir:v "1" ] ; fhir:lastUpdated [ fhir:v "2020-11-11T17:23:48.374+03:00"^^xsd:dateTime ] ] ; # fhir:text [ fhir:status [ fhir:v "generated" ] ; fhir:div "

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
"^^rdf:XMLLiteral ] ; # fhir:url [ fhir:v "http://nphies.sa/terminology/CodeSystem/adjudication-error"^^xsd:anyURI] ; # fhir:version [ fhir:v "0.3.0"] ; # fhir:name [ fhir:v "AdjudicationError"] ; # fhir:title [ fhir:v "Adjudication Error"] ; # fhir:status [ fhir:v "active"] ; # fhir:experimental [ fhir:v false] ; # fhir:date [ fhir:v "2025-06-23T22:09:21+03:00"^^xsd:dateTime] ; # fhir:publisher [ fhir:v "HL7 Saudi Arabia"] ; # fhir:contact ( [ fhir:name [ fhir:v "HL7 Saudi Arabia" ] ; fhir:telecom ( [ fhir:system [ fhir:v "url" ] ; fhir:value [ fhir:v "http://test-project.org/test-publisher" ] ] ) ] ) ; # fhir:description [ fhir:v "This code set includes a set of adjudication error codes which may be issued during the validation of a message."] ; # fhir:jurisdiction ( [ fhir:coding ( [ fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ; fhir:code [ fhir:v "SA" ] ; fhir:display [ fhir:v "Saudi Arabia" ] ] ) ] ) ; # fhir:copyright [ fhir:v "nphies 2020+ (https://nphies.sa)"] ; # fhir:caseSensitive [ fhir:v true] ; # fhir:compositional [ fhir:v false] ; # fhir:versionNeeded [ fhir:v false] ; # fhir:content [ fhir:v "fragment"] ; # fhir:concept ( [ fhir:code [ fhir:v "1191" ] ; fhir:display [ fhir:v "Missing element: [Patient] within the message" ] ] [ fhir:code [ fhir:v "1190" ] ; fhir:display [ fhir:v "Missing element: [Communication.note.text] within the message" ] ] [ fhir:code [ fhir:v "1199" ] ; fhir:display [ fhir:v "Missing element: [patient.birthDate] within the message" ] ] [ fhir:code [ fhir:v "1198" ] ; fhir:display [ fhir:v "Missing element: [gender.extensionKsaGender] within the message" ] ] [ fhir:code [ fhir:v "1197" ] ; fhir:display [ fhir:v "Missing element: [patient.gender ] within the message" ] ] [ fhir:code [ fhir:v "1196" ] ; fhir:display [ fhir:v "Missing element: [patient.name] within the message" ] ] [ fhir:code [ fhir:v "1195" ] ; fhir:display [ fhir:v "Missing element: [patient.active] within the message" ] ] [ fhir:code [ fhir:v "1194" ] ; fhir:display [ fhir:v "Missing element: [patient.identifier] within the message" ] ] [ fhir:code [ fhir:v "1193" ] ; fhir:display [ fhir:v "Missing element: [patient.id] within the message" ] ] [ fhir:code [ fhir:v "260" ] ; fhir:display [ fhir:v "Missing element: [Claim.careTeam.role] within the message" ] ] [ fhir:code [ fhir:v "1192" ] ; fhir:display [ fhir:v "Missing element: [patient.resourceType] within the message" ] ] [ fhir:code [ fhir:v "760" ] ; fhir:display [ fhir:v "Missing element: [Claim.insurance.coverage] within the message" ] ] [ fhir:code [ fhir:v "761" ] ; fhir:display [ fhir:v "Missing element: [Claim.insurance.preAuthRef] within the message" ] ] [ fhir:code [ fhir:v "762" ] ; fhir:display [ fhir:v "Missing element: [Claim.insurance.claimResponse] within the message" ] ] [ fhir:code [ fhir:v "261" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo] within the message" ] ] [ fhir:code [ fhir:v "763" ] ; fhir:display [ fhir:v "Missing element: [Claim.accident] within the message" ] ] [ fhir:code [ fhir:v "764" ] ; fhir:display [ fhir:v "Missing element: [Claim.accident.Date] within the message" ] ] [ fhir:code [ fhir:v "262" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo.sequence] within the message" ] ] [ fhir:code [ fhir:v "765" ] ; fhir:display [ fhir:v "Missing element: [Claim.accident.type] within the message" ] ] [ fhir:code [ fhir:v "1133" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.processNote] within the message" ] ] [ fhir:code [ fhir:v "263" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo.category] within the message" ] ] [ fhir:code [ fhir:v "766" ] ; fhir:display [ fhir:v "Missing element: [Claim.accident.locationAdress] within the message" ] ] [ fhir:code [ fhir:v "264" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo.code] within the message" ] ] [ fhir:code [ fhir:v "1625" ] ; fhir:display [ fhir:v "ClaimResponse.item.detail.Sequence detailSequence in the claim response SHALL match item.detail.sequence within the claim.item" ] ] [ fhir:code [ fhir:v "1132" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.fundsReserve] within the message" ] ] [ fhir:code [ fhir:v "767" ] ; fhir:display [ fhir:v "Missing element: [Claim.item] within the message" ] ] [ fhir:code [ fhir:v "34" ] ; fhir:display [ fhir:v "Missing element: [CoverageEligibilityResponse.patient] within the message" ] ] [ fhir:code [ fhir:v "265" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo.timingDate] within the message" ] ] [ fhir:code [ fhir:v "1189" ] ; fhir:display [ fhir:v "Missing element: [Communication.note.time] within the message" ] ] [ fhir:code [ fhir:v "1131" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.total.amount.currency] within the message" ] ] [ fhir:code [ fhir:v "768" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.extension.tax] within the message" ] ] [ fhir:code [ fhir:v "1130" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.total.amount.value] within the message" ] ] [ fhir:code [ fhir:v "266" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo.timingPeriod] within the message" ] ] [ fhir:code [ fhir:v "1624" ] ; fhir:display [ fhir:v "ClaimResponse.item.detail.Sequence detailSequence in the claim response SHALL match item.detail.sequence within the claim.item" ] ] [ fhir:code [ fhir:v "769" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.sequence] within the message" ] ] [ fhir:code [ fhir:v "35" ] ; fhir:display [ fhir:v "Missing element: [CoverageEligibilityResponse.servicedDate] within the message" ] ] [ fhir:code [ fhir:v "770" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.careTeamSequence] within the message" ] ] [ fhir:code [ fhir:v "267" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo.valueBoolean] within the message" ] ] [ fhir:code [ fhir:v "1672" ] ; fhir:display [ fhir:v "Services performed outside the coverage effective period" ] ] [ fhir:code [ fhir:v "36" ] ; fhir:display [ fhir:v "Missing element: [CoverageEligibilityResponse.created] within the message" ] ] [ fhir:code [ fhir:v "268" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo.valueString] within the message" ] ] [ fhir:code [ fhir:v "1177" ] ; fhir:display [ fhir:v "Missing element: [Communication.subject] within the message" ] ] [ fhir:code [ fhir:v "37" ] ; fhir:display [ fhir:v "Missing element: [CoverageEligibilityResponse.request] within the message" ] ] [ fhir:code [ fhir:v "269" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo.valueQuantity] within the message" ] ] [ fhir:code [ fhir:v "1176" ] ; fhir:display [ fhir:v "Missing element: [Communication.medium] within the message" ] ] [ fhir:code [ fhir:v "12" ] ; fhir:display [ fhir:v "Missing element: [entry.CoverageEligibilityRequest] within the message" ] ] [ fhir:code [ fhir:v "1671" ] ; fhir:display [ fhir:v "The requested medicine(s) is not registered" ] ] [ fhir:code [ fhir:v "38" ] ; fhir:display [ fhir:v "Missing element: [CoverageEligibilityResponse.outcome] within the message" ] ] [ fhir:code [ fhir:v "1175" ] ; fhir:display [ fhir:v "Missing element: [Communication.priority] within the message" ] ] [ fhir:code [ fhir:v "270" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo.valueAttachment] within the message" ] ] [ fhir:code [ fhir:v "340" ] ; fhir:display [ fhir:v "Missing element: [Claim.fundsReserve] within the message" ] ] [ fhir:code [ fhir:v "39" ] ; fhir:display [ fhir:v "Missing element: [CoverageEligibilityResponse.disposition] within the message" ] ] [ fhir:code [ fhir:v "1174" ] ; fhir:display [ fhir:v "Missing element: [Communication.category] within the message" ] ] [ fhir:code [ fhir:v "1670" ] ; fhir:display [ fhir:v "Service code is inconsistent with the patient's gender" ] ] [ fhir:code [ fhir:v "13" ] ; fhir:display [ fhir:v "Missing element: [CoverageEligibilityRequest.resourceType] within the message" ] ] [ fhir:code [ fhir:v "380" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.extension.tax] within the message" ] ] [ fhir:code [ fhir:v "271" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo.valueReference] within the message" ] ] [ fhir:code [ fhir:v "1669" ] ; fhir:display [ fhir:v "Diagnosis is inconsistent with the patient's gender" ] ] [ fhir:code [ fhir:v "14" ] ; fhir:display [ fhir:v "Missing element: [CoverageEligibilityRequest.id] within the message" ] ] [ fhir:code [ fhir:v "381" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.sequence] within the message" ] ] [ fhir:code [ fhir:v "1668" ] ; fhir:display [ fhir:v "Supporting information not related to the patient" ] ] [ fhir:code [ fhir:v "272" ] ; fhir:display [ fhir:v "Missing element: [Claim.supportingInfo.reason] within the message" ] ] [ fhir:code [ fhir:v "382" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.careTeamSequence] within the message" ] ] [ fhir:code [ fhir:v "1667" ] ; fhir:display [ fhir:v "The service code is invalid given the patient history" ] ] [ fhir:code [ fhir:v "1666" ] ; fhir:display [ fhir:v "Provider not licensed during the date of service" ] ] [ fhir:code [ fhir:v "273" ] ; fhir:display [ fhir:v "Missing element: [Claim.diagnosis] within the message" ] ] [ fhir:code [ fhir:v "1665" ] ; fhir:display [ fhir:v "New born exceeds 30 days of age" ] ] [ fhir:code [ fhir:v "274" ] ; fhir:display [ fhir:v "Missing element: [Claim.diagnosis.sequence] within the message" ] ] [ fhir:code [ fhir:v "1129" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.total.amount] within the message" ] ] [ fhir:code [ fhir:v "1664" ] ; fhir:display [ fhir:v "Policy is cancelled/expired" ] ] [ fhir:code [ fhir:v "275" ] ; fhir:display [ fhir:v "Missing element: [Claim.diagnosis.diagnosisCodeableConcept] within the message" ] ] [ fhir:code [ fhir:v "1663" ] ; fhir:display [ fhir:v "MEMBER DELETED" ] ] [ fhir:code [ fhir:v "1662" ] ; fhir:display [ fhir:v "Tooth number is missing" ] ] [ fhir:code [ fhir:v "276" ] ; fhir:display [ fhir:v "Missing element: [Claim.diagnosis.type] within the message" ] ] [ fhir:code [ fhir:v "1682" ] ; fhir:display [ fhir:v "The patient information does not match the insurance member details." ] ] [ fhir:code [ fhir:v "1128" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.total.category] within the message" ] ] [ fhir:code [ fhir:v "320" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.detail.subDetail.unitPrice] within the message" ] ] [ fhir:code [ fhir:v "277" ] ; fhir:display [ fhir:v "Missing element: [Claim.insurance] within the message" ] ] [ fhir:code [ fhir:v "1111" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.item.detail.noteNumber] within the message" ] ] [ fhir:code [ fhir:v "1127" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.total] within the message" ] ] [ fhir:code [ fhir:v "278" ] ; fhir:display [ fhir:v "Missing element: [Claim.insurance.sequence] within the message" ] ] [ fhir:code [ fhir:v "1126" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.item.detail.subDetail.adjudication.amount.currency] within the message" ] ] [ fhir:code [ fhir:v "279" ] ; fhir:display [ fhir:v "Missing element: [Claim.insurance.focal] within the message" ] ] [ fhir:code [ fhir:v "1125" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.item.detail.subDetail.adjudication.amount.value] within the message" ] ] [ fhir:code [ fhir:v "1595" ] ; fhir:display [ fhir:v "Claim serviced SHALL be on OR after the creation date if the claim use=Authorization" ] ] [ fhir:code [ fhir:v "56" ] ; fhir:display [ fhir:v "Missing element: [Claim.status] within the message" ] ] [ fhir:code [ fhir:v "700" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.detail.subDetail.sequence] within the message" ] ] [ fhir:code [ fhir:v "57" ] ; fhir:display [ fhir:v "Missing element: [Claim.type] within the message" ] ] [ fhir:code [ fhir:v "1124" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.item.detail.subDetail.adjudication.amount] within the message" ] ] [ fhir:code [ fhir:v "321" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.detail.subDetail.net] within the message" ] ] [ fhir:code [ fhir:v "1110" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.item.detail.detailSequence] within the message" ] ] [ fhir:code [ fhir:v "58" ] ; fhir:display [ fhir:v "Missing element: [Claim.subType] within the message" ] ] [ fhir:code [ fhir:v "701" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.detail.subDetail.productOrService] within the message" ] ] [ fhir:code [ fhir:v "771" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.diagnosisSequence] within the message" ] ] [ fhir:code [ fhir:v "59" ] ; fhir:display [ fhir:v "Missing element: [Claim.use] within the message" ] ] [ fhir:code [ fhir:v "1123" ] ; fhir:display [ fhir:v "Missing element: [ClaimResponse.item.detail.subDetail.adjudication.reason] within the message" ] ] [ fhir:code [ fhir:v "1594" ] ; fhir:display [ fhir:v "Claim.billablePeriod SHALL be within the encounter start and end date if encounter is provided" ] ] [ fhir:code [ fhir:v "322" ] ; fhir:display [ fhir:v "Missing element: [Claim.item.detail.subDetail.udi] within the message" ] ] [ fhir:code [ fhir:v "60" ] ; fhir:display [ fhir:v "Missing element: [Claim.patient] within the message" ] ] [ fhir:code [ fhir:v "1593" ] ; fhir:display [ fhir:v "Claim.subType If Claim type is profesional ,then the Claim sub-type SHALL not be IP" ] ] ) . # # -------------------------------------------------------------------------------------