FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 - Version 0.0.1-snapshot-2. See the Directory of published versions
| Page standards status: Informative | Maturity Level: 0 |
<ValueSet xmlns="http://hl7.org/fhir">
<id value="R5-v3-UnderwriterParticipationFunction-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-UnderwriterParticipationFunction-for-R4</b></p><a name="R5-v3-UnderwriterParticipationFunction-for-R4"> </a><a name="hcR5-v3-UnderwriterParticipationFunction-for-R4"> </a><p>This value set expansion contains 5 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-UnderwriterParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-PAYORCNTR"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ParticipationFunction.html#v3-ParticipationFunction-PAYORCNTR">PAYORCNTR</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</td><td>payor contracting</td><td><div><p><strong>Definition:</strong> Contracting for the provision and administration of health services to payors while retaining the risk for coverage. Contracting may be for all provision and administration; or for provision of certain types of services; for provision of services by region; and by types of administration, e.g., claims adjudication, enrollment, provider management, and utilization management. Typically done by underwriters for sponsors who need coverage provided to covered parties in multiple regions. The underwriter may act as the payor in some, but not all of the regions in which coverage is provided.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-UnderwriterParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-REINS"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ParticipationFunction.html#v3-ParticipationFunction-REINS">REINS</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</td><td>reinsures</td><td><div><p><strong>Definition:</strong> Underwriting reinsurance for another underwriter for the policy or program.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-UnderwriterParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-RETROCES"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ParticipationFunction.html#v3-ParticipationFunction-RETROCES">RETROCES</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</td><td>retrocessionaires</td><td><div><p><strong>Definition:</strong> Underwriting reinsurance for another reinsurer.</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-UnderwriterParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-SUBCTRT"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ParticipationFunction.html#v3-ParticipationFunction-SUBCTRT">SUBCTRT</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</td><td>subcontracting risk</td><td><div><p><strong>Definition:</strong> Delegating risk for a policy or program to one or more subcontracting underwriters, e.g., a major health insurer may delegate risk for provision of coverage under a national health plan to other underwriters by region .</p>
</div></td></tr><tr><td style="white-space:nowrap"><a name="R5-v3-UnderwriterParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-UNDERWRTNG"> </a> <a href="http://terminology.hl7.org/6.5.0/CodeSystem-v3-ParticipationFunction.html#v3-ParticipationFunction-UNDERWRTNG">UNDERWRTNG</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</td><td>underwriting</td><td><div><p><strong>Definition:</strong> Provision of underwriting analysis for another underwriter without assumption of risk.</p>
</div></td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="fhir"/>
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<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"/>
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<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"/>
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<url
value="http://hl7.org/fhir/5.0/ValueSet/R5-v3-UnderwriterParticipationFunction-for-R4"/>
<version value="0.0.1-snapshot-2"/>
<name value="R5_v3_UnderwriterParticipationFunction_for_R4"/>
<title
value="Cross-version VS for R5.UnderwriterParticipationFunction for use in FHIR R4"/>
<status value="active"/>
<experimental value="false"/>
<date value="2025-09-01T22:37:05.474734+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-UnderwriterParticipationFunction|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>
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<compose>
<include>
<system
value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
<version value="2.1.0"/>
<concept>
<code value="PAYORCNTR"/>
<display value="payor contracting"/>
</concept>
<concept>
<code value="REINS"/>
<display value="reinsures"/>
</concept>
<concept>
<code value="RETROCES"/>
<display value="retrocessionaires"/>
</concept>
<concept>
<code value="SUBCTRT"/>
<display value="subcontracting risk"/>
</concept>
<concept>
<code value="UNDERWRTNG"/>
<display value="underwriting"/>
</concept>
</include>
</compose>
<expansion>
<timestamp value="2025-09-01T22:37:05.474731+10:00"/>
<contains>
<system
value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
<version value="2.1.0"/>
<code value="PAYORCNTR"/>
<display value="payor contracting"/>
</contains>
<contains>
<system
value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
<version value="2.1.0"/>
<code value="REINS"/>
<display value="reinsures"/>
</contains>
<contains>
<system
value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
<version value="2.1.0"/>
<code value="RETROCES"/>
<display value="retrocessionaires"/>
</contains>
<contains>
<system
value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
<version value="2.1.0"/>
<code value="SUBCTRT"/>
<display value="subcontracting risk"/>
</contains>
<contains>
<system
value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
<version value="2.1.0"/>
<code value="UNDERWRTNG"/>
<display value="underwriting"/>
</contains>
</expansion>
</ValueSet>