Healthcare Financial Services IG Edition 1
0.3.0 - ci-build
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
ValueSet: Adjudication Error Codes
| Official URL: http://nphies.sa/terminology/ValueSet/adjudication-error | Version: 0.3.0 | |||
| Active as of 2023-08-13 | Computable Name: AdjudicationError | |||
Copyright/Legal: nphies 2020+ (https://nphies.sa) |
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Codes for errors encountered during the processing of the adjudication.
References
- Nphies Cancel Response
- Nphies Claim Response
- Nphies CoverageEligibilityResponse
- Nphies Poll Response
- Nphies Authorization Response
- Nphies Status Response
Logical Definition (CLD)
Generated Narrative: ValueSet adjudication-error
version: 15
- Include all codes defined in
http://nphies.sa/terminology/CodeSystem/adjudication-error
Expansion
ValueSet
Expansion based on code system fragment http://nphies.sa/terminology/CodeSystem/adjudication-error Adjudication Error v0.3.0 (CodeSystem)
Expansion performed internally based on codesystem Adjudication Error v0.3.0 (CodeSystem)
This value set contains at least 100 concepts
| Code | System | Display (en-US) |
| 1191 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Patient] within the message |
| 1190 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Communication.note.text] within the message |
| 1199 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [patient.birthDate] within the message |
| 1198 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [gender.extensionKsaGender] within the message |
| 1197 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [patient.gender ] within the message |
| 1196 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [patient.name] within the message |
| 1195 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [patient.active] within the message |
| 1194 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [patient.identifier] within the message |
| 1193 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [patient.id] within the message |
| 260 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.careTeam.role] within the message |
| 1192 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [patient.resourceType] within the message |
| 760 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.insurance.coverage] within the message |
| 761 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.insurance.preAuthRef] within the message |
| 762 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.insurance.claimResponse] within the message |
| 261 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo] within the message |
| 763 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.accident] within the message |
| 764 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.accident.Date] within the message |
| 262 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo.sequence] within the message |
| 765 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.accident.type] within the message |
| 1133 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.processNote] within the message |
| 263 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo.category] within the message |
| 766 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.accident.locationAdress] within the message |
| 264 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo.code] within the message |
| 1625 | http://nphies.sa/terminology/CodeSystem/adjudication-error | ClaimResponse.item.detail.Sequence detailSequence in the claim response SHALL match item.detail.sequence within the claim.item |
| 1132 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.fundsReserve] within the message |
| 767 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item] within the message |
| 34 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [CoverageEligibilityResponse.patient] within the message |
| 265 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo.timingDate] within the message |
| 1189 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Communication.note.time] within the message |
| 1131 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.total.amount.currency] within the message |
| 768 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.extension.tax] within the message |
| 1130 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.total.amount.value] within the message |
| 266 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo.timingPeriod] within the message |
| 1624 | http://nphies.sa/terminology/CodeSystem/adjudication-error | ClaimResponse.item.detail.Sequence detailSequence in the claim response SHALL match item.detail.sequence within the claim.item |
| 769 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.sequence] within the message |
| 35 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [CoverageEligibilityResponse.servicedDate] within the message |
| 770 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.careTeamSequence] within the message |
| 267 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo.valueBoolean] within the message |
| 1672 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Services performed outside the coverage effective period |
| 36 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [CoverageEligibilityResponse.created] within the message |
| 268 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo.valueString] within the message |
| 1177 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Communication.subject] within the message |
| 37 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [CoverageEligibilityResponse.request] within the message |
| 269 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo.valueQuantity] within the message |
| 1176 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Communication.medium] within the message |
| 12 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [entry.CoverageEligibilityRequest] within the message |
| 1671 | http://nphies.sa/terminology/CodeSystem/adjudication-error | The requested medicine(s) is not registered |
| 38 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [CoverageEligibilityResponse.outcome] within the message |
| 1175 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Communication.priority] within the message |
| 270 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo.valueAttachment] within the message |
| 340 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.fundsReserve] within the message |
| 39 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [CoverageEligibilityResponse.disposition] within the message |
| 1174 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Communication.category] within the message |
| 1670 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Service code is inconsistent with the patient's gender |
| 13 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [CoverageEligibilityRequest.resourceType] within the message |
| 380 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.extension.tax] within the message |
| 271 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo.valueReference] within the message |
| 1669 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Diagnosis is inconsistent with the patient's gender |
| 14 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [CoverageEligibilityRequest.id] within the message |
| 381 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.sequence] within the message |
| 1668 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Supporting information not related to the patient |
| 272 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.supportingInfo.reason] within the message |
| 382 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.careTeamSequence] within the message |
| 1667 | http://nphies.sa/terminology/CodeSystem/adjudication-error | The service code is invalid given the patient history |
| 1666 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Provider not licensed during the date of service |
| 273 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.diagnosis] within the message |
| 1665 | http://nphies.sa/terminology/CodeSystem/adjudication-error | New born exceeds 30 days of age |
| 274 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.diagnosis.sequence] within the message |
| 1129 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.total.amount] within the message |
| 1664 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Policy is cancelled/expired |
| 275 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.diagnosis.diagnosisCodeableConcept] within the message |
| 1663 | http://nphies.sa/terminology/CodeSystem/adjudication-error | MEMBER DELETED |
| 1662 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Tooth number is missing |
| 276 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.diagnosis.type] within the message |
| 1682 | http://nphies.sa/terminology/CodeSystem/adjudication-error | The patient information does not match the insurance member details. |
| 1128 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.total.category] within the message |
| 320 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.detail.subDetail.unitPrice] within the message |
| 277 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.insurance] within the message |
| 1111 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.item.detail.noteNumber] within the message |
| 1127 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.total] within the message |
| 278 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.insurance.sequence] within the message |
| 1126 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.item.detail.subDetail.adjudication.amount.currency] within the message |
| 279 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.insurance.focal] within the message |
| 1125 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.item.detail.subDetail.adjudication.amount.value] within the message |
| 1595 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Claim serviced SHALL be on OR after the creation date if the claim use=Authorization |
| 56 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.status] within the message |
| 700 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.detail.subDetail.sequence] within the message |
| 57 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.type] within the message |
| 1124 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.item.detail.subDetail.adjudication.amount] within the message |
| 321 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.detail.subDetail.net] within the message |
| 1110 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.item.detail.detailSequence] within the message |
| 58 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.subType] within the message |
| 701 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.detail.subDetail.productOrService] within the message |
| 771 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.diagnosisSequence] within the message |
| 59 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.use] within the message |
| 1123 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [ClaimResponse.item.detail.subDetail.adjudication.reason] within the message |
| 1594 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Claim.billablePeriod SHALL be within the encounter start and end date if encounter is provided |
| 322 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.item.detail.subDetail.udi] within the message |
| 60 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Missing element: [Claim.patient] within the message |
| 1593 | http://nphies.sa/terminology/CodeSystem/adjudication-error | Claim.subType If Claim type is profesional ,then the Claim sub-type SHALL not be IP |
Explanation of the columns that may appear on this page:
| Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies |
| System | The source of the definition of the code (when the value set draws in codes defined elsewhere) |
| Code | The code (used as the code in the resource instance) |
| Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application |
| Definition | An explanation of the meaning of the concept |
| Comments | Additional notes about how to use the code |