# text.div
This code system http://hl7.org/fhir/claim-decision-reason defines the following codes:

Code | Display | Definition
0001 | Not medically necessary | The payer has determined this product, service, or procedure as not medically necessary.
0002 | Prior authorization not obtained | Prior authorization was not obtained prior to providing the product, service, or procedure.
0003 | Provider out-of-network | This provider is considered out-of-network by the payer for this plan.
0004 | Service inconsistent with patient age | The payer has determined this product, service, or procedure is not consistent with the patient's age.
0005 | Benefit limits exceeded | The patient or subscriber benefit's have been exceeded.

# title
Claim Adjudication Decision Reason Codes

# description
This value set provides example Claim Adjudication Decision Reason codes.

# concept[].definition
The payer has determined this product, service, or procedure as not medically necessary.

# concept[].definition
Prior authorization was not obtained prior to providing the product, service, or procedure.

# concept[].definition
This provider is considered out-of-network by the payer for this plan.

# concept[].definition
The payer has determined this product, service, or procedure is not consistent with the patient's age.

# concept[].definition
The patient or subscriber benefit's have been exceeded.