FHIR Implementation Guide for HCX
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: HCX Claim Denial Codes - XML Representation

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="claim-denial-codes"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <url
       value="https://ig.hcxprotocol.io/v0.8/ValueSet-claim-denial-codes.html"/>
  <version value="0.8.0"/>
  <name value="ClaimDenialCodes"/>
  <status value="active"/>
  <date value="2021-08-15"/>
  <publisher value="HCX Open Community"/>
  <contact>
    <name value="HCX Open Community"/>
    <telecom>
      <system value="url"/>
      <value value="http://hcxprotocol.io/"/>
    </telecom>
  </contact>
  <description
               value="This is the value set that includes the codes for understanding of the adjudication result and explaining variance from expected amount"/>
  <expansion>
    <timestamp value="2021-08-15T08:15:30+05:30"/>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="ELIG-001"/>
      <display value="Patient is not a covered member"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="ELIG-005"/>
      <display value="Services performed after the last date of coverage"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="ELIG-006"/>
      <display
               value="Services performed prior to the effective date of coverage"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="ELIG-007"/>
      <display value="Services performed by a non-network provider"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="AUTH-001"/>
      <display value="Prior approval is required and was not obtained"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="AUTH-003"/>
      <display value="PriorAuthorizationNumber is invalid"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="AUTH-004"/>
      <display
               value="Service(s) is (are) performed outside authorization validity date"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="AUTH-005"/>
      <display
               value="Claim information is inconsistent with pre-certified/authorized services"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="AUTH-006"/>
      <display
               value="Alert drug - drug interaction or drug is contra-indicated"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="AUTH-007"/>
      <display value="Drug duplicate therapy"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="AUTH-008"/>
      <display value="Inappropriate drug dose"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="AUTH-009"/>
      <display value="Prescription out of date"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="AUTH-010"/>
      <display
               value="Authorization request overlaps or is within the period of another paid claim or approved authorization"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="AUTH-011"/>
      <display value="Waiting period on pre-existing / specific conditions"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="AUTH-012"/>
      <display value="Request for information"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="BENX-002"/>
      <display
               value="Benefit maximum for this time period or occurrence has been reached"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="BENX-005"/>
      <display value="Annual limit/sublimit amount exceeded"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CLAI-007"/>
      <display
               value="Claim is a work-related injury/illness and thus the liability of the employer"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CLAI-008"/>
      <display
               value="Claim overlaps inpatient stay. Resubmit only those services rendered outside the inpatient stay"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CLAI-009"/>
      <display value="Date of birth follows the date of service"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CLAI-010"/>
      <display value="Date of death precedes the date of service"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CLAI-011"/>
      <display
               value="Inpatient admission spans multiple rate periods.  Resubmit separate claims"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CLAI-012"/>
      <display
               value="Submission not compliant with contractual agreement between provider &amp; payer"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CLAI-014"/>
      <display
               value="Claim not compliant with Resubmission type (used only for resubmissions)"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CLAI-017"/>
      <display value="Services not available on direct billing"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CLAI-018"/>
      <display value="Claims Recalled By Provider"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CODE-010"/>
      <display
               value="Activity/diagnosis inconsistent with clinician specialty"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CODE-012"/>
      <display
               value="Encounter type inconsistent with service(s) / diagnosis"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CODE-013"/>
      <display value="Invalid principal diagnosis"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CODE-014"/>
      <display
               value="Activity/diagnosis is inconsistent with the patient's age/gender"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CODE-015"/>
      <display
               value="Activity/diagnosis is inconsistent with the provider type"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="DUPL-001"/>
      <display value="Claim is a duplicate based on service codes and dates"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="DUPL-002"/>
      <display
               value="Payment already made for same/similar service within set time frame"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="MNEC-003"/>
      <display
               value="Service is not clinically indicated based on good clinical practice"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="MNEC-004"/>
      <display
               value="Service is not clinically indicated based on good clinical practice, without additional supporting diagnoses/activities"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="MNEC-005"/>
      <display value="Service/supply may be appropriate, but too frequent"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="MNEC-006"/>
      <display value="Alternative service should have been utilized"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="NCOV-001"/>
      <display value="Diagnosis(es) is (are) not covered"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="NCOV-002"/>
      <display value="Pre-existing conditions are not covered"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="NCOV-003"/>
      <display value="Service(s) is (are) not covered"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="NCOV-025"/>
      <display value="Service(s) is (are) not performed (used after audit)"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="PRCE-001"/>
      <display value="Calculation discrepancy"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="PRCE-002"/>
      <display
               value="Payment is included in the allowance for another service"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="PRCE-003"/>
      <display value="Recovery of Payment"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="PRCE-006"/>
      <display value="Consultation within free follow up period"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="PRCE-007"/>
      <display value="Service has no contract price"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="PRCE-008"/>
      <display value="Multiple procedure payment rules incorrectly applied"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="PRCE-009"/>
      <display value="Charges inconsistent with clinician specialty"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="PRCE-010"/>
      <display value="Use bundled code"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="PRCE-011"/>
      <display value="Discount discrepancy"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="TIME-001"/>
      <display value="Time limit for submission has expired"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="TIME-002"/>
      <display
               value="Requested additional information was not received or was not received within time limit"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="TIME-003"/>
      <display value="Appeal procedures not followed or time limits not met"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="COPY-001"/>
      <display value="Deductible/co-pay not collected from member"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="SURC-001"/>
      <display value="Severe drug - drug interaction"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="SURC-002"/>
      <display value="Severe drug - age contraindication"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="SURC-003"/>
      <display value="Severe drug - gender contraindication"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="SURC-004"/>
      <display value="Severe drug - diaganosis contraindication"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="SURC-005"/>
      <display value="Severe procedure\service - diagnosis contraindication"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="SURC-006"/>
      <display value="Severe procedure\service - drug contraindication"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="SURC-007"/>
      <display value="Severe procedure\service - procedure contraindication"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="SURC-008"/>
      <display value="Serious safety issue with drug dose"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="WRNG-001"/>
      <display
               value="Wrong submission, receiver is not responsible for the payer within this transaction submission."/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CLAI-019"/>
      <display value="Wrong IR-DRG code"/>
    </contains>
    <contains>
      <system value="http://hcxprotocol.io/codes/denial-code"/>
      <code value="CLAI-020"/>
      <display value="Missing IR-DRG code"/>
    </contains>
  </expansion>
</ValueSet>