Health Care Decision Reason Codes are supported in the Health Care Services Review Response Implementation Guide (version 4050). The HCR03 data element references this code source in version 4050 and later.

Denials are handled thorough the use of the HCR03 using the Health Care Decision Reason Code List.

• Start
  Every code has a Start date. This is the date when the code was first available in the code list.
• Last Modified
  When populated, this is the date of the code list release when the definition of the specific code was last modified by the committee. Modifications are defined as minor changes such as typos or clarification to the description. Major modifications would require a new code to be added.
• Stop
  When populated, this date identifies that the code can no longer be used in original business messages.

Health Care Services Decision Reason Codes FAQ

Health Care Services Decision Reason Codes are used to indicate the primary reason for the certification action code assigned as part of a health care services review.

• What do the Start, Last Modified, and Stop dates mean?
• Where are they used?
• Where aren't they used?
• How are they maintained?
• Who maintains the list?
• Where are the committee's minutes?
• How do I request a change?
• How do I monitor my change request?

Health Care Services Decision Reason Codes - Current

Health Care Services Decision Reason Codes are used to indicate the primary reason for the certification action code assigned as part of a health care services review.