FHIR Implementation Guide for HCX
0.7.0 - CI Build

FHIR Implementation Guide for HCX - Local Development build (v0.7.0). See the Directory of published versions

: HCX Claim Error Codes - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:ValueSet;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "claim-error-codes"];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This value set contains 65 concepts</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>System</b></td><td><b>Display</b></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-ELIG-001\"> </a>  ELIG-001</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Patient is not a covered member</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-ELIG-005\"> </a>  ELIG-005</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Services performed after the last date of coverage</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-ELIG-006\"> </a>  ELIG-006</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Services performed prior to the effective date of coverage</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-ELIG-007\"> </a>  ELIG-007</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Services performed by a non-network provider</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-AUTH-001\"> </a>  AUTH-001</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Prior approval is required and was not obtained</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-AUTH-003\"> </a>  AUTH-003</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>PriorAuthorizationNumber is invalid</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-AUTH-004\"> </a>  AUTH-004</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Service(s) is (are) performed outside authorization validity date</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-AUTH-005\"> </a>  AUTH-005</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Claim information is inconsistent with pre-certified/authorized services</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-AUTH-006\"> </a>  AUTH-006</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Alert drug - drug interaction or drug is contra-indicated</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-AUTH-007\"> </a>  AUTH-007</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Drug duplicate therapy</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-AUTH-008\"> </a>  AUTH-008</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Inappropriate drug dose</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-AUTH-009\"> </a>  AUTH-009</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Prescription out of date</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-AUTH-010\"> </a>  AUTH-010</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Authorization request overlaps or is within the period of another paid claim or approved authorization</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-AUTH-011\"> </a>  AUTH-011</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Waiting period on pre-existing / specific conditions</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-AUTH-012\"> </a>  AUTH-012</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Request for information</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-BENX-002\"> </a>  BENX-002</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Benefit maximum for this time period or occurrence has been reached</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-BENX-005\"> </a>  BENX-005</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Annual limit/sublimit amount exceeded</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CLAI-007\"> </a>  CLAI-007</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Claim is a work-related injury/illness and thus the liability of the employer</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CLAI-008\"> </a>  CLAI-008</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Claim overlaps inpatient stay. Resubmit only those services rendered outside the inpatient stay</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CLAI-009\"> </a>  CLAI-009</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Date of birth follows the date of service</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CLAI-010\"> </a>  CLAI-010</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Date of death precedes the date of service</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CLAI-011\"> </a>  CLAI-011</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Inpatient admission spans multiple rate periods. Resubmit separate claims</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CLAI-012\"> </a>  CLAI-012</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Submission not compliant with contractual agreement between provider &amp; payer</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CLAI-014\"> </a>  CLAI-014</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Claim not compliant with Resubmission type (used only for resubmissions)</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CLAI-017\"> </a>  CLAI-017</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Services not available on direct billing</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CLAI-018\"> </a>  CLAI-018</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Claims Recalled By Provider</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CODE-010\"> </a>  CODE-010</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Activity/diagnosis inconsistent with clinician specialty</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CODE-012\"> </a>  CODE-012</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Encounter type inconsistent with service(s) / diagnosis</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CODE-013\"> </a>  CODE-013</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Invalid principal diagnosis</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CODE-014\"> </a>  CODE-014</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Activity/diagnosis is inconsistent with the patient's age/gender</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CODE-015\"> </a>  CODE-015</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Activity/diagnosis is inconsistent with the provider type</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-DUPL-001\"> </a>  DUPL-001</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Claim is a duplicate based on service codes and dates</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-DUPL-002\"> </a>  DUPL-002</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Payment already made for same/similar service within set time frame</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-MNEC-003\"> </a>  MNEC-003</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Service is not clinically indicated based on good clinical practice</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-MNEC-004\"> </a>  MNEC-004</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Service is not clinically indicated based on good clinical practice, without additional supporting diagnoses/activities</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-MNEC-005\"> </a>  MNEC-005</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Service/supply may be appropriate, but too frequent</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-MNEC-006\"> </a>  MNEC-006</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Alternative service should have been utilized</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-NCOV-001\"> </a>  NCOV-001</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Diagnosis(es) is (are) not covered</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-NCOV-002\"> </a>  NCOV-002</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Pre-existing conditions are not covered</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-NCOV-003\"> </a>  NCOV-003</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Service(s) is (are) not covered</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-NCOV-025\"> </a>  NCOV-025</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Service(s) is (are) not performed (used after audit)</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-PRCE-001\"> </a>  PRCE-001</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Calculation discrepancy</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-PRCE-002\"> </a>  PRCE-002</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Payment is included in the allowance for another service</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-PRCE-003\"> </a>  PRCE-003</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Recovery of Payment</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-PRCE-006\"> </a>  PRCE-006</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Consultation within free follow up period</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-PRCE-007\"> </a>  PRCE-007</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Service has no contract price</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-PRCE-008\"> </a>  PRCE-008</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Multiple procedure payment rules incorrectly applied</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-PRCE-009\"> </a>  PRCE-009</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Charges inconsistent with clinician specialty</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-PRCE-010\"> </a>  PRCE-010</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Use bundled code</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-PRCE-011\"> </a>  PRCE-011</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Discount discrepancy</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-TIME-001\"> </a>  TIME-001</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Time limit for submission has expired</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-TIME-002\"> </a>  TIME-002</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Requested additional information was not received or was not received within time limit</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-TIME-003\"> </a>  TIME-003</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Appeal procedures not followed or time limits not met</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-COPY-001\"> </a>  COPY-001</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Deductible/co-pay not collected from member</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-SURC-001\"> </a>  SURC-001</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Severe drug - drug interaction</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-SURC-002\"> </a>  SURC-002</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Severe drug - age contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-SURC-003\"> </a>  SURC-003</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Severe drug - gender contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-SURC-004\"> </a>  SURC-004</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Severe drug - diaganosis contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-SURC-005\"> </a>  SURC-005</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Severe procedure\\service - diagnosis contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-SURC-006\"> </a>  SURC-006</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Severe procedure\\service - drug contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-SURC-007\"> </a>  SURC-007</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Severe procedure\\service - procedure contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-SURC-008\"> </a>  SURC-008</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Serious safety issue with drug dose</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-WRNG-001\"> </a>  WRNG-001</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Wrong submission, receiver is not responsible for the payer within this transaction submission.</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CLAI-019\"> </a>  CLAI-019</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Wrong IR-DRG code</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-claim-error-codes-CLAI-020\"> </a>  CLAI-020</td><td>http://hcxprotocol.io/codes/claim-error-codes</td><td>Missing IR-DRG code</td></tr></table></div>"
  ];
  fhir:ValueSet.url [ fhir:value "https://ig.hcxprotocol.io/v0.7/ValueSet-claim-error-codes.html"];
  fhir:ValueSet.version [ fhir:value "0.7.0"];
  fhir:ValueSet.name [ fhir:value "ClaimErrorCodes"];
  fhir:ValueSet.status [ fhir:value "active"];
  fhir:ValueSet.date [ fhir:value "2022-08-01"^^xsd:date];
  fhir:ValueSet.publisher [ fhir:value "HCX Open Community"];
  fhir:ValueSet.contact [
     fhir:index 0;
     fhir:ContactDetail.name [ fhir:value "HCX Open Community" ];
     fhir:ContactDetail.telecom [
       fhir:index 0;
       fhir:ContactPoint.system [ fhir:value "url" ];
       fhir:ContactPoint.value [ fhir:value "http://hcxprotocol.io/" ]     ]
  ];
  fhir:ValueSet.description [ fhir:value "This is the value set for claim error codes"];
  fhir:ValueSet.expansion [
     fhir:ValueSet.expansion.timestamp [ fhir:value "2022-08-01T08:15:30+05:30"^^xsd:dateTime ];
     fhir:ValueSet.expansion.contains [
       fhir:index 0;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "ELIG-001" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Patient is not a covered member" ]     ], [
       fhir:index 1;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "ELIG-005" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Services performed after the last date of coverage" ]     ], [
       fhir:index 2;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "ELIG-006" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Services performed prior to the effective date of coverage" ]     ], [
       fhir:index 3;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "ELIG-007" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Services performed by a non-network provider" ]     ], [
       fhir:index 4;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "AUTH-001" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Prior approval is required and was not obtained" ]     ], [
       fhir:index 5;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "AUTH-003" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "PriorAuthorizationNumber is invalid" ]     ], [
       fhir:index 6;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "AUTH-004" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Service(s) is (are) performed outside authorization validity date" ]     ], [
       fhir:index 7;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "AUTH-005" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Claim information is inconsistent with pre-certified/authorized services" ]     ], [
       fhir:index 8;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "AUTH-006" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Alert drug - drug interaction or drug is contra-indicated" ]     ], [
       fhir:index 9;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "AUTH-007" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Drug duplicate therapy" ]     ], [
       fhir:index 10;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "AUTH-008" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Inappropriate drug dose" ]     ], [
       fhir:index 11;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "AUTH-009" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Prescription out of date" ]     ], [
       fhir:index 12;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "AUTH-010" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Authorization request overlaps or is within the period of another paid claim or approved authorization" ]     ], [
       fhir:index 13;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "AUTH-011" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Waiting period on pre-existing / specific conditions" ]     ], [
       fhir:index 14;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "AUTH-012" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Request for information" ]     ], [
       fhir:index 15;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "BENX-002" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Benefit maximum for this time period or occurrence has been reached" ]     ], [
       fhir:index 16;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "BENX-005" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Annual limit/sublimit amount exceeded" ]     ], [
       fhir:index 17;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CLAI-007" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Claim is a work-related injury/illness and thus the liability of the employer" ]     ], [
       fhir:index 18;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CLAI-008" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Claim overlaps inpatient stay. Resubmit only those services rendered outside the inpatient stay" ]     ], [
       fhir:index 19;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CLAI-009" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Date of birth follows the date of service" ]     ], [
       fhir:index 20;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CLAI-010" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Date of death precedes the date of service" ]     ], [
       fhir:index 21;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CLAI-011" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Inpatient admission spans multiple rate periods. Resubmit separate claims" ]     ], [
       fhir:index 22;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CLAI-012" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Submission not compliant with contractual agreement between provider & payer" ]     ], [
       fhir:index 23;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CLAI-014" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Claim not compliant with Resubmission type (used only for resubmissions)" ]     ], [
       fhir:index 24;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CLAI-017" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Services not available on direct billing" ]     ], [
       fhir:index 25;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CLAI-018" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Claims Recalled By Provider" ]     ], [
       fhir:index 26;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CODE-010" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Activity/diagnosis inconsistent with clinician specialty" ]     ], [
       fhir:index 27;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CODE-012" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Encounter type inconsistent with service(s) / diagnosis" ]     ], [
       fhir:index 28;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CODE-013" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Invalid principal diagnosis" ]     ], [
       fhir:index 29;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CODE-014" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Activity/diagnosis is inconsistent with the patient's age/gender" ]     ], [
       fhir:index 30;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CODE-015" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Activity/diagnosis is inconsistent with the provider type" ]     ], [
       fhir:index 31;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "DUPL-001" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Claim is a duplicate based on service codes and dates" ]     ], [
       fhir:index 32;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "DUPL-002" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Payment already made for same/similar service within set time frame" ]     ], [
       fhir:index 33;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "MNEC-003" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Service is not clinically indicated based on good clinical practice" ]     ], [
       fhir:index 34;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "MNEC-004" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Service is not clinically indicated based on good clinical practice, without additional supporting diagnoses/activities" ]     ], [
       fhir:index 35;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "MNEC-005" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Service/supply may be appropriate, but too frequent" ]     ], [
       fhir:index 36;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "MNEC-006" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Alternative service should have been utilized" ]     ], [
       fhir:index 37;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "NCOV-001" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Diagnosis(es) is (are) not covered" ]     ], [
       fhir:index 38;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "NCOV-002" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Pre-existing conditions are not covered" ]     ], [
       fhir:index 39;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "NCOV-003" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Service(s) is (are) not covered" ]     ], [
       fhir:index 40;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "NCOV-025" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Service(s) is (are) not performed (used after audit)" ]     ], [
       fhir:index 41;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "PRCE-001" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Calculation discrepancy" ]     ], [
       fhir:index 42;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "PRCE-002" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Payment is included in the allowance for another service" ]     ], [
       fhir:index 43;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "PRCE-003" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Recovery of Payment" ]     ], [
       fhir:index 44;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "PRCE-006" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Consultation within free follow up period" ]     ], [
       fhir:index 45;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "PRCE-007" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Service has no contract price" ]     ], [
       fhir:index 46;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "PRCE-008" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Multiple procedure payment rules incorrectly applied" ]     ], [
       fhir:index 47;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "PRCE-009" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Charges inconsistent with clinician specialty" ]     ], [
       fhir:index 48;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "PRCE-010" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Use bundled code" ]     ], [
       fhir:index 49;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "PRCE-011" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Discount discrepancy" ]     ], [
       fhir:index 50;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "TIME-001" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Time limit for submission has expired" ]     ], [
       fhir:index 51;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "TIME-002" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Requested additional information was not received or was not received within time limit" ]     ], [
       fhir:index 52;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "TIME-003" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Appeal procedures not followed or time limits not met" ]     ], [
       fhir:index 53;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "COPY-001" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Deductible/co-pay not collected from member" ]     ], [
       fhir:index 54;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "SURC-001" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Severe drug - drug interaction" ]     ], [
       fhir:index 55;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "SURC-002" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Severe drug - age contraindication" ]     ], [
       fhir:index 56;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "SURC-003" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Severe drug - gender contraindication" ]     ], [
       fhir:index 57;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "SURC-004" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Severe drug - diaganosis contraindication" ]     ], [
       fhir:index 58;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "SURC-005" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Severe procedure\\service - diagnosis contraindication" ]     ], [
       fhir:index 59;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "SURC-006" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Severe procedure\\service - drug contraindication" ]     ], [
       fhir:index 60;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "SURC-007" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Severe procedure\\service - procedure contraindication" ]     ], [
       fhir:index 61;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "SURC-008" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Serious safety issue with drug dose" ]     ], [
       fhir:index 62;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "WRNG-001" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Wrong submission, receiver is not responsible for the payer within this transaction submission." ]     ], [
       fhir:index 63;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CLAI-019" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Wrong IR-DRG code" ]     ], [
       fhir:index 64;
       fhir:ValueSet.expansion.contains.system [ fhir:value "http://hcxprotocol.io/codes/claim-error-codes" ];
       fhir:ValueSet.expansion.contains.code [ fhir:value "CLAI-020" ];
       fhir:ValueSet.expansion.contains.display [ fhir:value "Missing IR-DRG code" ]     ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.