Release 4

Codesystem-insuranceplan-applicability.json

Patient Administration Work GroupMaturity Level: N/AStandards Status: Informative

Raw JSON (canonical form + also see JSON Format Specification)

Definition for Code System BenefitCostApplicability

{
  "resourceType" : "CodeSystem",
  "id" : "insuranceplan-applicability",
  "meta" : {
    "lastUpdated" : "2021-01-21T15:34:20.265+00:00",
    "profile" : ["http://hl7.org/fhir/StructureDefinition/shareablecodesystem"]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div>!-- Snipped for Brevity --></div>"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "pa"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 0
  }],
  "url" : "http://terminology.hl7.org/CodeSystem/applicability",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.1.0"
  }],
  "version" : "4.0.1",
  "name" : "BenefitCostApplicability",
  "title" : "Benefit cost applicability",
  "status" : "draft",
  "experimental" : false,
  "date" : "2018-06-05T14:06:02+00:00",
  "publisher" : "HL7 (FHIR Project)",
  "contact" : [{
    "telecom" : [{
      "system" : "url",
      "value" : "http://hl7.org/fhir"
    },
    {
      "system" : "email",
      "value" : "fhir@lists.hl7.org"
    }]
  },
  {
    "telecom" : [{
      "system" : "url",
      "value" : "http://hl7.org/fhir"
    },
    {
      "system" : "email",
      "value" : "fhir@lists.hl7.org"
    }]
  }],
  "description" : "Whether the cost applies to in-network or out-of-network providers.",
  "caseSensitive" : true,
  "valueSet" : "http://hl7.org/fhir/ValueSet/insuranceplan-applicability",
  "content" : "complete",
  "concept" : [{
    "code" : "in-network",
    "display" : "In Network",
    "definition" : "Provider is contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates"
  },
  {
    "code" : "out-of-network",
    "display" : "Out of Network",
    "definition" : "Provider is  not contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates"
  },
  {
    "code" : "other",
    "display" : "Other",
    "definition" : "Other applicability"
  }]
}

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.