{ "resourceType" : "ValueSet", "id" : "R5-v3-ActInvoiceOverrideCode-for-R3", "text" : { "status" : "generated", "div" : "

Generated Narrative: ValueSet R5-v3-ActInvoiceOverrideCode-for-R3

This value set expansion contains 15 concepts.

SystemVersionCodeDisplayDefinition
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0COVGEcoverage problem

Insurance coverage problems have been encountered. Additional explanation information to be supplied.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0EFORMelectronic form to follow

Electronic form with supporting or additional information to follow.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0FAXfax to follow

Fax with supporting or additional information to follow.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0GFTHgood faith indicator

The medical service was provided to a patient in good faith that they had medical coverage, although no evidence of coverage was available before service was rendered.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0LATElate invoice

Knowingly over the payor's published time limit for this invoice possibly due to a previous payor's delays in processing. Additional reason information will be supplied.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0MANUALmanual review

Manual review of the invoice is requested. Additional information to be supplied. This may be used in the case of an appeal.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0OOJout of jurisdiction

The medical service and/or product was provided to a patient that has coverage in another jurisdiction.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0ORTHOorthodontic service

The service provided is required for orthodontic purposes. If the covered party has orthodontic coverage, then the service may be paid.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0PAPERpaper documentation to follow

Paper documentation (or other physical format) with supporting or additional information to follow.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0PIEpublic insurance exhausted

Public Insurance has been exhausted. Invoice has not been sent to Public Insuror and therefore no Explanation Of Benefits (EOB) is provided with this Invoice submission.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0PYRDELAYdelayed by a previous payor

Allows provider to explain lateness of invoice to a subsequent payor.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0REFNRreferral not required

Rules of practice do not require a physician's referral for the provider to perform a billable service.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0REPSERVrepeated service

The same service was delivered within a time period that would usually indicate a duplicate billing. However, the repeated service is a medical necessity and therefore not a duplicate.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0UNRELATunrelated service

The service provided is not related to another billed service. For example, 2 unrelated services provided on the same day to the same patient which may normally result in a refused payment for one of the items.

\n
http://terminology.hl7.org/CodeSystem/v3-ActCode8.0.0\u00a0\u00a0VERBAUTHverbal authorization

The provider has received a verbal permission from an authoritative source to perform the service or supply the item being invoiced.

\n
" }, "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode" : "fhir" }, { "extension" : [{ "url" : "packageId", "valueId" : "hl7.fhir.uv.xver-r5.r3" }, { "url" : "version", "valueString" : "0.1.0" }, { "url" : "uri", "valueUri" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r3" }], "url" : "http://hl7.org/fhir/StructureDefinition/package-source" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger" : 0, "_valueInteger" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom", "valueUri" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r3" }] } }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode" : "trial-use", "_valueCode" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom", "valueUri" : "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r3" }] } }], "url" : "http://hl7.org/fhir/uv/xver/ValueSet/R5-v3-ActInvoiceOverrideCode-for-R3", "version" : "0.1.0", "name" : "R5V3ActInvoiceOverrideCodeForR3", "title" : "Cross-version ValueSet R5.ActInvoiceOverrideCode for use in FHIR STU3", "status" : "active", "experimental" : false, "date" : "2026-03-17T21:02:03.8104715+00:00", "publisher" : "FHIR Infrastructure", "contact" : [{ "name" : "FHIR Infrastructure", "telecom" : [{ "system" : "url", "value" : "http://www.hl7.org/Special/committees/fiwg" }] }], "description" : "This cross-version ValueSet represents content from `http://terminology.hl7.org/ValueSet/v3-ActInvoiceOverrideCode|2.0.0` for use in FHIR STU3.", "jurisdiction" : [{ "coding" : [{ "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm", "code" : "001", "display" : "World" }] }], "purpose" : "This value set is part of the cross-version definitions generated to enable use of the\r\nvalue set `http://terminology.hl7.org/ValueSet/v3-ActInvoiceOverrideCode|2.0.0` as defined in FHIR R5\r\nin FHIR STU3.\r\n\r\nThe source value set is bound to the following FHIR R5 elements:\r\n* \r\n\r\nNote that all concepts are included in this cross-version definition because no concepts have compatible representations\r\n\r\nFollowing are the generation technical comments:\r\n\nFHIR ValueSet `http://terminology.hl7.org/ValueSet/v3-ActInvoiceOverrideCode|2.0.0`, defined in FHIR R5 does not have any mapping to FHIR STU3", "compose" : { "include" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "concept" : [{ "code" : "COVGE", "display" : "coverage problem" }, { "code" : "EFORM", "display" : "electronic form to follow" }, { "code" : "FAX", "display" : "fax to follow" }, { "code" : "GFTH", "display" : "good faith indicator" }, { "code" : "LATE", "display" : "late invoice" }, { "code" : "MANUAL", "display" : "manual review" }, { "code" : "OOJ", "display" : "out of jurisdiction" }, { "code" : "ORTHO", "display" : "orthodontic service" }, { "code" : "PAPER", "display" : "paper documentation to follow" }, { "code" : "PIE", "display" : "public insurance exhausted" }, { "code" : "PYRDELAY", "display" : "delayed by a previous payor" }, { "code" : "REFNR", "display" : "referral not required" }, { "code" : "REPSERV", "display" : "repeated service" }, { "code" : "UNRELAT", "display" : "unrelated service" }, { "code" : "VERBAUTH", "display" : "verbal authorization" }] }] }, "expansion" : { "timestamp" : "2026-03-17T21:02:03.8104715+00:00", "contains" : [{ "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "COVGE", "display" : "coverage problem" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "EFORM", "display" : "electronic form to follow" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "FAX", "display" : "fax to follow" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "GFTH", "display" : "good faith indicator" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "LATE", "display" : "late invoice" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "MANUAL", "display" : "manual review" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "OOJ", "display" : "out of jurisdiction" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "ORTHO", "display" : "orthodontic service" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "PAPER", "display" : "paper documentation to follow" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "PIE", "display" : "public insurance exhausted" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "PYRDELAY", "display" : "delayed by a previous payor" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "REFNR", "display" : "referral not required" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "REPSERV", "display" : "repeated service" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "UNRELAT", "display" : "unrelated service" }, { "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode", "version" : "8.0.0", "code" : "VERBAUTH", "display" : "verbal authorization" }] } }