FHIR Implementation Guide for HCX
0.8.0 - CI Build
FHIR Implementation Guide for HCX
0.8.0 - CI Build
FHIR Implementation Guide for HCX - Local Development build (v0.8.0). See the Directory of published versions
@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-error-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-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 & 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:url [ fhir:v "https://ig.hcxprotocol.io/v0.8/ValueSet-claim-error-codes.html"^^xsd:anyURI] ; #
fhir:version [ fhir:v "0.8.0"] ; #
fhir:name [ fhir:v "ClaimErrorCodes"] ; #
fhir:status [ fhir:v "active"] ; #
fhir:date [ fhir:v "2022-08-01"^^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 for claim error codes"] ; #
fhir:expansion [
fhir:timestamp [ fhir:v "2022-08-01T08:15:30+05:30"^^xsd:dateTime ] ;
( fhir:contains [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-003" ] ;
fhir:display [ fhir:v "PriorAuthorizationNumber is invalid" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-007" ] ;
fhir:display [ fhir:v "Drug duplicate therapy" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-008" ] ;
fhir:display [ fhir:v "Inappropriate drug dose" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-009" ] ;
fhir:display [ fhir:v "Prescription out of date" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "AUTH-012" ] ;
fhir:display [ fhir:v "Request for information" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-018" ] ;
fhir:display [ fhir:v "Claims Recalled By Provider" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CODE-013" ] ;
fhir:display [ fhir:v "Invalid principal diagnosis" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-001" ] ;
fhir:display [ fhir:v "Calculation discrepancy" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^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/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-003" ] ;
fhir:display [ fhir:v "Recovery of Payment" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-010" ] ;
fhir:display [ fhir:v "Use bundled code" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "PRCE-011" ] ;
fhir:display [ fhir:v "Discount discrepancy" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-001" ] ;
fhir:display [ fhir:v "Severe drug - drug interaction" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-002" ] ;
fhir:display [ fhir:v "Severe drug - age contraindication" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-003" ] ;
fhir:display [ fhir:v "Severe drug - gender contraindication" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "SURC-004" ] ;
fhir:display [ fhir:v "Severe drug - diaganosis contraindication" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^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/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-019" ] ;
fhir:display [ fhir:v "Wrong IR-DRG code" ] ] [
fhir:system [ fhir:v "http://hcxprotocol.io/codes/claim-error-codes"^^xsd:anyURI ] ;
fhir:code [ fhir:v "CLAI-020" ] ;
fhir:display [ fhir:v "Missing IR-DRG code" ] ] )
] . #
IG © 2021+ HCX Open Community. Package hcxprotocol.io#0.8.0 based on FHIR 4.0.1. Generated 2023-03-15
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