HCXPROTOCOL.IO\HCX Claim Denial Codes - TTL Representation

FHIR Implementation Guide for HCX - Local Development build (v0.8.0). See the Directory of published versions
: HCX Claim Denial Codes - TTL Representation


@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:id [ fhir:v "claim-denial-codes"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir: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-denial-code-ELIG-001\"> </a>  ELIG-001</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Patient is not a covered member</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-ELIG-005\"> </a>  ELIG-005</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Services performed after the last date of coverage</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-ELIG-006\"> </a>  ELIG-006</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-ELIG-007\"> </a>  ELIG-007</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Services performed by a non-network provider</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-AUTH-001\"> </a>  AUTH-001</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Prior approval is required and was not obtained</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-AUTH-003\"> </a>  AUTH-003</td><td>http://hcxprotocol.io/codes/denial-code</td><td>PriorAuthorizationNumber is invalid</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-AUTH-004\"> </a>  AUTH-004</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-AUTH-005\"> </a>  AUTH-005</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-AUTH-006\"> </a>  AUTH-006</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-AUTH-007\"> </a>  AUTH-007</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Drug duplicate therapy</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-AUTH-008\"> </a>  AUTH-008</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Inappropriate drug dose</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-AUTH-009\"> </a>  AUTH-009</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Prescription out of date</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-AUTH-010\"> </a>  AUTH-010</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-AUTH-011\"> </a>  AUTH-011</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Waiting period on pre-existing / specific conditions</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-AUTH-012\"> </a>  AUTH-012</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Request for information</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-BENX-002\"> </a>  BENX-002</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-BENX-005\"> </a>  BENX-005</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Annual limit/sublimit amount exceeded</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-CLAI-007\"> </a>  CLAI-007</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-CLAI-008\"> </a>  CLAI-008</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-CLAI-009\"> </a>  CLAI-009</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Date of birth follows the date of service</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-CLAI-010\"> </a>  CLAI-010</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Date of death precedes the date of service</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-CLAI-011\"> </a>  CLAI-011</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-CLAI-012\"> </a>  CLAI-012</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-CLAI-014\"> </a>  CLAI-014</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-CLAI-017\"> </a>  CLAI-017</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Services not available on direct billing</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-CLAI-018\"> </a>  CLAI-018</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Claims Recalled By Provider</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-CODE-010\"> </a>  CODE-010</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Activity/diagnosis inconsistent with clinician specialty</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-CODE-012\"> </a>  CODE-012</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Encounter type inconsistent with service(s) / diagnosis</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-CODE-013\"> </a>  CODE-013</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Invalid principal diagnosis</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-CODE-014\"> </a>  CODE-014</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-CODE-015\"> </a>  CODE-015</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Activity/diagnosis is inconsistent with the provider type</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-DUPL-001\"> </a>  DUPL-001</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-DUPL-002\"> </a>  DUPL-002</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-MNEC-003\"> </a>  MNEC-003</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-MNEC-004\"> </a>  MNEC-004</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-MNEC-005\"> </a>  MNEC-005</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Service/supply may be appropriate, but too frequent</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-MNEC-006\"> </a>  MNEC-006</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Alternative service should have been utilized</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-NCOV-001\"> </a>  NCOV-001</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Diagnosis(es) is (are) not covered</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-NCOV-002\"> </a>  NCOV-002</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Pre-existing conditions are not covered</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-NCOV-003\"> </a>  NCOV-003</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Service(s) is (are) not covered</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-NCOV-025\"> </a>  NCOV-025</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-PRCE-001\"> </a>  PRCE-001</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Calculation discrepancy</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-PRCE-002\"> </a>  PRCE-002</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-PRCE-003\"> </a>  PRCE-003</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Recovery of Payment</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-PRCE-006\"> </a>  PRCE-006</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Consultation within free follow up period</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-PRCE-007\"> </a>  PRCE-007</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Service has no contract price</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-PRCE-008\"> </a>  PRCE-008</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Multiple procedure payment rules incorrectly applied</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-PRCE-009\"> </a>  PRCE-009</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Charges inconsistent with clinician specialty</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-PRCE-010\"> </a>  PRCE-010</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Use bundled code</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-PRCE-011\"> </a>  PRCE-011</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Discount discrepancy</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-TIME-001\"> </a>  TIME-001</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Time limit for submission has expired</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-TIME-002\"> </a>  TIME-002</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-TIME-003\"> </a>  TIME-003</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-COPY-001\"> </a>  COPY-001</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Deductible/co-pay not collected from member</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-SURC-001\"> </a>  SURC-001</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Severe drug - drug interaction</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-SURC-002\"> </a>  SURC-002</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Severe drug - age contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-SURC-003\"> </a>  SURC-003</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Severe drug - gender contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-SURC-004\"> </a>  SURC-004</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Severe drug - diaganosis contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-SURC-005\"> </a>  SURC-005</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Severe procedure\\service - diagnosis contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-SURC-006\"> </a>  SURC-006</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Severe procedure\\service - drug contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-SURC-007\"> </a>  SURC-007</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Severe procedure\\service - procedure contraindication</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-SURC-008\"> </a>  SURC-008</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Serious safety issue with drug dose</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-WRNG-001\"> </a>  WRNG-001</td><td>http://hcxprotocol.io/codes/denial-code</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-denial-code-CLAI-019\"> </a>  CLAI-019</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Wrong IR-DRG code</td></tr><tr><td style=\"white-space:nowrap\"><a name=\"http---hcxprotocol.io-codes-denial-code-CLAI-020\"> </a>  CLAI-020</td><td>http://hcxprotocol.io/codes/denial-code</td><td>Missing IR-DRG code</td></tr></table></div>"
  ] ; # 
  fhir:url [ fhir:v "https://ig.hcxprotocol.io/v0.8/ValueSet-claim-denial-codes.html"^^xsd:anyURI] ; # 
  fhir:version [ fhir:v "0.8.0"] ; # 
  fhir:name [ fhir:v "ClaimDenialCodes"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:date [ fhir:v "2021-08-15"^^xsd:date] ; # 
  fhir:publisher [ fhir:v "HCX Open Community"] ; # 
  fhir:contact ( [
fhir:name [ fhir:v "HCX Open Community" ] ;
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://hcxprotocol.io/" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "This is the value set that includes the codes for understanding of the adjudication result and explaining variance from expected amount"] ; # 
  fhir:expansion [
fhir:timestamp [ fhir:v "2021-08-15T08:15:30+05:30"^^xsd:dateTime ] ;
    ( fhir:contains [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ELIG-001" ] ;
fhir:display [ fhir:v "Patient is not a covered member" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ELIG-005" ] ;
fhir:display [ fhir:v "Services performed after the last date of coverage" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ELIG-006" ] ;
fhir:display [ fhir:v "Services performed prior to the effective date of coverage" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "ELIG-007" ] ;
fhir:display [ fhir:v "Services performed by a non-network provider" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-001" ] ;
fhir:display [ fhir:v "Prior approval is required and was not obtained" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-003" ] ;
fhir:display [ fhir:v "PriorAuthorizationNumber is invalid" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-004" ] ;
fhir:display [ fhir:v "Service(s) is (are) performed outside authorization validity date" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-005" ] ;
fhir:display [ fhir:v "Claim information is inconsistent with pre-certified/authorized services" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-006" ] ;
fhir:display [ fhir:v "Alert drug - drug interaction or drug is contra-indicated" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-007" ] ;
fhir:display [ fhir:v "Drug duplicate therapy" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-008" ] ;
fhir:display [ fhir:v "Inappropriate drug dose" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-009" ] ;
fhir:display [ fhir:v "Prescription out of date" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-010" ] ;
fhir:display [ fhir:v "Authorization request overlaps or is within the period of another paid claim or approved authorization" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-011" ] ;
fhir:display [ fhir:v "Waiting period on pre-existing / specific conditions" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-012" ] ;
fhir:display [ fhir:v "Request for information" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "BENX-002" ] ;
fhir:display [ fhir:v "Benefit maximum for this time period or occurrence has been reached" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "BENX-005" ] ;
fhir:display [ fhir:v "Annual limit/sublimit amount exceeded" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-007" ] ;
fhir:display [ fhir:v "Claim is a work-related injury/illness and thus the liability of the employer" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-008" ] ;
fhir:display [ fhir:v "Claim overlaps inpatient stay. Resubmit only those services rendered outside the inpatient stay" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-009" ] ;
fhir:display [ fhir:v "Date of birth follows the date of service" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-010" ] ;
fhir:display [ fhir:v "Date of death precedes the date of service" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-011" ] ;
fhir:display [ fhir:v "Inpatient admission spans multiple rate periods.  Resubmit separate claims" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-012" ] ;
fhir:display [ fhir:v "Submission not compliant with contractual agreement between provider & payer" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-014" ] ;
fhir:display [ fhir:v "Claim not compliant with Resubmission type (used only for resubmissions)" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-017" ] ;
fhir:display [ fhir:v "Services not available on direct billing" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-018" ] ;
fhir:display [ fhir:v "Claims Recalled By Provider" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CODE-010" ] ;
fhir:display [ fhir:v "Activity/diagnosis inconsistent with clinician specialty" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CODE-012" ] ;
fhir:display [ fhir:v "Encounter type inconsistent with service(s) / diagnosis" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CODE-013" ] ;
fhir:display [ fhir:v "Invalid principal diagnosis" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CODE-014" ] ;
fhir:display [ fhir:v "Activity/diagnosis is inconsistent with the patient's age/gender" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CODE-015" ] ;
fhir:display [ fhir:v "Activity/diagnosis is inconsistent with the provider type" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DUPL-001" ] ;
fhir:display [ fhir:v "Claim is a duplicate based on service codes and dates" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "DUPL-002" ] ;
fhir:display [ fhir:v "Payment already made for same/similar service within set time frame" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "MNEC-003" ] ;
fhir:display [ fhir:v "Service is not clinically indicated based on good clinical practice" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "MNEC-004" ] ;
fhir:display [ fhir:v "Service is not clinically indicated based on good clinical practice, without additional supporting diagnoses/activities" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "MNEC-005" ] ;
fhir:display [ fhir:v "Service/supply may be appropriate, but too frequent" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "MNEC-006" ] ;
fhir:display [ fhir:v "Alternative service should have been utilized" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "NCOV-001" ] ;
fhir:display [ fhir:v "Diagnosis(es) is (are) not covered" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "NCOV-002" ] ;
fhir:display [ fhir:v "Pre-existing conditions are not covered" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "NCOV-003" ] ;
fhir:display [ fhir:v "Service(s) is (are) not covered" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "NCOV-025" ] ;
fhir:display [ fhir:v "Service(s) is (are) not performed (used after audit)" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-001" ] ;
fhir:display [ fhir:v "Calculation discrepancy" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-002" ] ;
fhir:display [ fhir:v "Payment is included in the allowance for another service" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-003" ] ;
fhir:display [ fhir:v "Recovery of Payment" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-006" ] ;
fhir:display [ fhir:v "Consultation within free follow up period" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-007" ] ;
fhir:display [ fhir:v "Service has no contract price" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-008" ] ;
fhir:display [ fhir:v "Multiple procedure payment rules incorrectly applied" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-009" ] ;
fhir:display [ fhir:v "Charges inconsistent with clinician specialty" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-010" ] ;
fhir:display [ fhir:v "Use bundled code" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-011" ] ;
fhir:display [ fhir:v "Discount discrepancy" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TIME-001" ] ;
fhir:display [ fhir:v "Time limit for submission has expired" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TIME-002" ] ;
fhir:display [ fhir:v "Requested additional information was not received or was not received within time limit" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "TIME-003" ] ;
fhir:display [ fhir:v "Appeal procedures not followed or time limits not met" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "COPY-001" ] ;
fhir:display [ fhir:v "Deductible/co-pay not collected from member" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-001" ] ;
fhir:display [ fhir:v "Severe drug - drug interaction" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-002" ] ;
fhir:display [ fhir:v "Severe drug - age contraindication" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-003" ] ;
fhir:display [ fhir:v "Severe drug - gender contraindication" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-004" ] ;
fhir:display [ fhir:v "Severe drug - diaganosis contraindication" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-005" ] ;
fhir:display [ fhir:v "Severe procedure\\service - diagnosis contraindication" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-006" ] ;
fhir:display [ fhir:v "Severe procedure\\service - drug contraindication" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-007" ] ;
fhir:display [ fhir:v "Severe procedure\\service - procedure contraindication" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-008" ] ;
fhir:display [ fhir:v "Serious safety issue with drug dose" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "WRNG-001" ] ;
fhir:display [ fhir:v "Wrong submission, receiver is not responsible for the payer within this transaction submission." ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-019" ] ;
fhir:display [ fhir:v "Wrong IR-DRG code" ]     ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/denial-code"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-020" ] ;
fhir:display [ fhir:v "Missing IR-DRG code" ]     ] )
  ] . #