FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5
0.0.1-snapshot-2 - informative International flag

FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 - Version 0.0.1-snapshot-2. See the Directory of published versions

: Cross-version VS for R5.CoverageEligibilityReason for use in FHIR R4 - JSON Representation

Page standards status: Informative Maturity Level: 0

Raw json | Download

{
  "resourceType" : "ValueSet",
  "id" : "R5-v3-CoverageEligibilityReason-for-R4",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet R5-v3-CoverageEligibilityReason-for-R4</b></p><a name=\"R5-v3-CoverageEligibilityReason-for-R4\"> </a><a name=\"hcR5-v3-CoverageEligibilityReason-for-R4\"> </a><p>This value set expansion contains 11 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><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-CoverageEligibilityReason-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActReason-AGE\"> </a>\u00a0\u00a0<a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActReason.html#v3-ActReason-AGE\">AGE</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActReason</td><td>age eligibility</td><td><div><p>A person becomes eligible for a program based on age.</p>\n<p><em>Example:</em>  In the U.S., a person who is 65 years of age or older is eligible for Medicare.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-CoverageEligibilityReason-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActReason-CRIME\"> </a>\u00a0\u00a0<a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActReason.html#v3-ActReason-CRIME\">CRIME</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActReason</td><td>crime victim</td><td><div><p>A person becomes eligible for insurance or a program because of crime related health condition or injury.</p>\n<p><em>Example:</em>  A person is a claimant under the U.S. Crime Victims Compensation program.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-CoverageEligibilityReason-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActReason-DIS\"> </a>\u00a0\u00a0<a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActReason.html#v3-ActReason-DIS\">DIS</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActReason</td><td>disability</td><td><div><p>A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-CoverageEligibilityReason-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActReason-EMPLOY\"> </a>\u00a0\u00a0<a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActReason.html#v3-ActReason-EMPLOY\">EMPLOY</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActReason</td><td>employment benefit</td><td><div><p>A person becomes eligible for insurance provided as an employment benefit based on employment status.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-CoverageEligibilityReason-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActReason-FINAN\"> </a>\u00a0\u00a0<a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActReason.html#v3-ActReason-FINAN\">FINAN</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActReason</td><td>financial eligibility</td><td><div><p>A person becomes eligible for a program based on financial criteria.</p>\n<p><em>Example:</em>  A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-CoverageEligibilityReason-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActReason-HEALTH\"> </a>\u00a0\u00a0<a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActReason.html#v3-ActReason-HEALTH\">HEALTH</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActReason</td><td>health status</td><td><div><p>A person becomes eligible for a program because of a qualifying health condition or injury.</p>\n<p><em>Examples:</em>  A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-CoverageEligibilityReason-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActReason-MULTI\"> </a>\u00a0\u00a0<a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActReason.html#v3-ActReason-MULTI\">MULTI</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActReason</td><td>multiple criteria eligibility</td><td><div><p>A person becomes eligible for a program based on more than one criterion.</p>\n<p><em>Examples:</em>  In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-CoverageEligibilityReason-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActReason-PNC\"> </a>\u00a0\u00a0<a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActReason.html#v3-ActReason-PNC\">PNC</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActReason</td><td>property and casualty condition</td><td><div><p>A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy.</p>\n<p><em>Example:</em>  A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-CoverageEligibilityReason-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActReason-STATUTORY\"> </a>\u00a0\u00a0<a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActReason.html#v3-ActReason-STATUTORY\">STATUTORY</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActReason</td><td>statutory eligibility</td><td><div><p>A person becomes eligible for a program based on statutory criteria.</p>\n<p><em>Examples:</em>  A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-CoverageEligibilityReason-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActReason-VEHIC\"> </a>\u00a0\u00a0<a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActReason.html#v3-ActReason-VEHIC\">VEHIC</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActReason</td><td>motor vehicle accident victim</td><td><div><p>A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-CoverageEligibilityReason-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActReason-WORK\"> </a>\u00a0\u00a0<a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ActReason.html#v3-ActReason-WORK\">WORK</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ActReason</td><td>work related</td><td><div><p>A person becomes eligible for insurance or a program because of a work related health condition or injury.</p>\n<p><em>Example:</em>  A person is a claimant under the U.S. Black Lung Program.</p>\n</div></td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "fhir"
    },
    {
      "extension" : [
        {
          "url" : "packageId",
          "valueId" : "hl7.fhir.uv.xver-r5.r4"
        },
        {
          "url" : "version",
          "valueString" : "0.0.1-snapshot-2"
        }
      ],
      "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",
            "valueCanonical" : "http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"
          }
        ]
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "informative",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/5.0/ValueSet/R5-v3-CoverageEligibilityReason-for-R4",
  "version" : "0.0.1-snapshot-2",
  "name" : "R5_v3_CoverageEligibilityReason_for_R4",
  "title" : "Cross-version VS for R5.CoverageEligibilityReason for use in FHIR R4",
  "status" : "active",
  "experimental" : false,
  "date" : "2025-09-01T22:37:05.089101+10:00",
  "publisher" : "FHIR Infrastructure",
  "contact" : [
    {
      "name" : "FHIR Infrastructure",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fiwg"
        }
      ]
    }
  ],
  "description" : "This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-CoverageEligibilityReason|2.0.0 for use in FHIR R4. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code" : "001",
          "display" : "World"
        }
      ]
    }
  ],
  "compose" : {
    "include" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "concept" : [
          {
            "code" : "AGE",
            "display" : "age eligibility"
          },
          {
            "code" : "CRIME",
            "display" : "crime victim"
          },
          {
            "code" : "DIS",
            "display" : "disability"
          },
          {
            "code" : "EMPLOY",
            "display" : "employment benefit"
          },
          {
            "code" : "FINAN",
            "display" : "financial eligibility"
          },
          {
            "code" : "HEALTH",
            "display" : "health status"
          },
          {
            "code" : "MULTI",
            "display" : "multiple criteria eligibility"
          },
          {
            "code" : "PNC",
            "display" : "property and casualty condition"
          },
          {
            "code" : "STATUTORY",
            "display" : "statutory eligibility"
          },
          {
            "code" : "VEHIC",
            "display" : "motor vehicle accident victim"
          },
          {
            "code" : "WORK",
            "display" : "work related"
          }
        ]
      }
    ]
  },
  "expansion" : {
    "timestamp" : "2025-09-01T22:37:05.089094+10:00",
    "contains" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "code" : "AGE",
        "display" : "age eligibility"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "code" : "CRIME",
        "display" : "crime victim"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "code" : "DIS",
        "display" : "disability"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "code" : "EMPLOY",
        "display" : "employment benefit"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "code" : "FINAN",
        "display" : "financial eligibility"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "code" : "HEALTH",
        "display" : "health status"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "code" : "MULTI",
        "display" : "multiple criteria eligibility"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "code" : "PNC",
        "display" : "property and casualty condition"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "code" : "STATUTORY",
        "display" : "statutory eligibility"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "code" : "VEHIC",
        "display" : "motor vehicle accident victim"
      },
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "version" : "2.1.0",
        "code" : "WORK",
        "display" : "work related"
      }
    ]
  }
}