FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5
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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 - XML Representation

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="R5-v3-CoverageEligibilityReason-for-R4"/>
  <text>
    <status value="generated"/>
    <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>  <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>
<p><em>Example:</em>  In the U.S., a person who is 65 years of age or older is eligible for Medicare.</p>
</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>  <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>
<p><em>Example:</em>  A person is a claimant under the U.S. Crime Victims Compensation program.</p>
</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>  <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>
</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>  <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>
</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>  <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>
<p><em>Example:</em>  A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP.</p>
</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>  <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>
<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>
</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>  <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>
<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>
</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>  <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>
<p><em>Example:</em>  A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises.</p>
</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>  <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>
<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>
</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>  <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>
</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>  <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>
<p><em>Example:</em>  A person is a claimant under the U.S. Black Lung Program.</p>
</div></td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fhir"/>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/package-source">
    <extension url="packageId">
      <valueId value="hl7.fhir.uv.xver-r5.r4"/>
    </extension>
    <extension url="version">
      <valueString value="0.0.1-snapshot-2"/>
    </extension>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="0">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"/>
      </extension>
    </valueInteger>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="informative">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://hl7.org/fhir/5.0/ValueSet/R5-v3-CoverageEligibilityReason-for-R4"/>
  <version value="0.0.1-snapshot-2"/>
  <name value="R5_v3_CoverageEligibilityReason_for_R4"/>
  <title
         value="Cross-version VS for R5.CoverageEligibilityReason for use in FHIR R4"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2025-09-01T22:37:05.089101+10:00"/>
  <publisher value="FHIR Infrastructure"/>
  <contact>
    <name value="FHIR Infrastructure"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fiwg"/>
    </telecom>
  </contact>
  <description
               value="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 value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </coding>
  </jurisdiction>
  <compose>
    <include>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <concept>
        <code value="AGE"/>
        <display value="age eligibility"/>
      </concept>
      <concept>
        <code value="CRIME"/>
        <display value="crime victim"/>
      </concept>
      <concept>
        <code value="DIS"/>
        <display value="disability"/>
      </concept>
      <concept>
        <code value="EMPLOY"/>
        <display value="employment benefit"/>
      </concept>
      <concept>
        <code value="FINAN"/>
        <display value="financial eligibility"/>
      </concept>
      <concept>
        <code value="HEALTH"/>
        <display value="health status"/>
      </concept>
      <concept>
        <code value="MULTI"/>
        <display value="multiple criteria eligibility"/>
      </concept>
      <concept>
        <code value="PNC"/>
        <display value="property and casualty condition"/>
      </concept>
      <concept>
        <code value="STATUTORY"/>
        <display value="statutory eligibility"/>
      </concept>
      <concept>
        <code value="VEHIC"/>
        <display value="motor vehicle accident victim"/>
      </concept>
      <concept>
        <code value="WORK"/>
        <display value="work related"/>
      </concept>
    </include>
  </compose>
  <expansion>
    <timestamp value="2025-09-01T22:37:05.089094+10:00"/>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <code value="AGE"/>
      <display value="age eligibility"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <code value="CRIME"/>
      <display value="crime victim"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <code value="DIS"/>
      <display value="disability"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <code value="EMPLOY"/>
      <display value="employment benefit"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <code value="FINAN"/>
      <display value="financial eligibility"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <code value="HEALTH"/>
      <display value="health status"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <code value="MULTI"/>
      <display value="multiple criteria eligibility"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <code value="PNC"/>
      <display value="property and casualty condition"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <code value="STATUTORY"/>
      <display value="statutory eligibility"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <code value="VEHIC"/>
      <display value="motor vehicle accident victim"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <version value="2.1.0"/>
      <code value="WORK"/>
      <display value="work related"/>
    </contains>
  </expansion>
</ValueSet>