Extensions for Using Data Elements from FHIR R5 in FHIR R4
0.1.0 - STU International flag

Extensions for Using Data Elements from FHIR R5 in FHIR R4 - Downloaded Version null See the Directory of published versions

: R5V3ActInvoiceOverrideCodeForR4 - XML Representation

Page standards status: Trial-use Maturity Level: 0

Raw xml | Download


<ValueSet xmlns="http://hl7.org/fhir">
  <id value="R5-v3-ActInvoiceOverrideCode-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-ActInvoiceOverrideCode-for-R4</b></p><a name="R5-v3-ActInvoiceOverrideCode-for-R4"> </a><a name="hcR5-v3-ActInvoiceOverrideCode-for-R4"> </a><p>This value set expansion contains 15 concepts.</p><table class="codes"><tr><td><b>System</b></td><td><b>Version</b></td><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-COVGE"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-COVGE">COVGE</a></td><td>coverage problem</td><td><div><p>Insurance coverage problems have been encountered. Additional explanation information to be supplied.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-EFORM"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-EFORM">EFORM</a></td><td>electronic form to follow</td><td><div><p>Electronic form with supporting or additional information to follow.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-FAX"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-FAX">FAX</a></td><td>fax to follow</td><td><div><p>Fax with supporting or additional information to follow.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-GFTH"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-GFTH">GFTH</a></td><td>good faith indicator</td><td><div><p>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.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-LATE"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-LATE">LATE</a></td><td>late invoice</td><td><div><p>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.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-MANUAL"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-MANUAL">MANUAL</a></td><td>manual review</td><td><div><p>Manual review of the invoice is requested. Additional information to be supplied. This may be used in the case of an appeal.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-OOJ"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-OOJ">OOJ</a></td><td>out of jurisdiction</td><td><div><p>The medical service and/or product was provided to a patient that has coverage in another jurisdiction.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-ORTHO"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-ORTHO">ORTHO</a></td><td>orthodontic service</td><td><div><p>The service provided is required for orthodontic purposes. If the covered party has orthodontic coverage, then the service may be paid.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-PAPER"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-PAPER">PAPER</a></td><td>paper documentation to follow</td><td><div><p>Paper documentation (or other physical format) with supporting or additional information to follow.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-PIE"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-PIE">PIE</a></td><td>public insurance exhausted</td><td><div><p>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.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-PYRDELAY"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-PYRDELAY">PYRDELAY</a></td><td>delayed by a previous payor</td><td><div><p>Allows provider to explain lateness of invoice to a subsequent payor.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-REFNR"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-REFNR">REFNR</a></td><td>referral not required</td><td><div><p>Rules of practice do not require a physician's referral for the provider to perform a billable service.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-REPSERV"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-REPSERV">REPSERV</a></td><td>repeated service</td><td><div><p>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.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-UNRELAT"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-UNRELAT">UNRELAT</a></td><td>unrelated service</td><td><div><p>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.</p>
</div></td></tr><tr><td><a name="R5-v3-ActInvoiceOverrideCode-for-R4-http://terminology.hl7.org/CodeSystem/v3-ActCode-VERBAUTH"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></td><td>8.0.0</td><td style="white-space:nowrap">  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-VERBAUTH">VERBAUTH</a></td><td>verbal authorization</td><td><div><p>The provider has received a verbal permission from an authoritative source to perform the service or supply the item being invoiced.</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="0.1.0"/>
    </extension>
    <extension url="uri">
      <valueUri
                value="http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"/>
    </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/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"/>
      </extension>
    </valueInteger>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://hl7.org/fhir/uv/xver/ValueSet/R5-v3-ActInvoiceOverrideCode-for-R4"/>
  <version value="0.1.0"/>
  <name value="R5V3ActInvoiceOverrideCodeForR4"/>
  <title
         value="Cross-version ValueSet R5.ActInvoiceOverrideCode for use in FHIR R4"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2026-03-17T21:02:03.8104715+00:00"/>
  <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 content from `http://terminology.hl7.org/ValueSet/v3-ActInvoiceOverrideCode|2.0.0` for use in FHIR R4."/>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </coding>
  </jurisdiction>
  <purpose
           value="This value set is part of the cross-version definitions generated to enable use of the
value set `http://terminology.hl7.org/ValueSet/v3-ActInvoiceOverrideCode|2.0.0` as defined in FHIR R5
in FHIR R4.

The source value set is bound to the following FHIR R5 elements:
* 

Note that all concepts are included in this cross-version definition because no concepts have compatible representations

Following are the generation technical comments:

FHIR ValueSet `http://terminology.hl7.org/ValueSet/v3-ActInvoiceOverrideCode|2.0.0`, defined in FHIR R5 does not have any mapping to FHIR R4"/>
  <compose>
    <include>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <concept>
        <code value="COVGE"/>
        <display value="coverage problem"/>
      </concept>
      <concept>
        <code value="EFORM"/>
        <display value="electronic form to follow"/>
      </concept>
      <concept>
        <code value="FAX"/>
        <display value="fax to follow"/>
      </concept>
      <concept>
        <code value="GFTH"/>
        <display value="good faith indicator"/>
      </concept>
      <concept>
        <code value="LATE"/>
        <display value="late invoice"/>
      </concept>
      <concept>
        <code value="MANUAL"/>
        <display value="manual review"/>
      </concept>
      <concept>
        <code value="OOJ"/>
        <display value="out of jurisdiction"/>
      </concept>
      <concept>
        <code value="ORTHO"/>
        <display value="orthodontic service"/>
      </concept>
      <concept>
        <code value="PAPER"/>
        <display value="paper documentation to follow"/>
      </concept>
      <concept>
        <code value="PIE"/>
        <display value="public insurance exhausted"/>
      </concept>
      <concept>
        <code value="PYRDELAY"/>
        <display value="delayed by a previous payor"/>
      </concept>
      <concept>
        <code value="REFNR"/>
        <display value="referral not required"/>
      </concept>
      <concept>
        <code value="REPSERV"/>
        <display value="repeated service"/>
      </concept>
      <concept>
        <code value="UNRELAT"/>
        <display value="unrelated service"/>
      </concept>
      <concept>
        <code value="VERBAUTH"/>
        <display value="verbal authorization"/>
      </concept>
    </include>
  </compose>
  <expansion>
    <timestamp value="2026-03-17T21:02:03.8104715+00:00"/>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="COVGE"/>
      <display value="coverage problem"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="EFORM"/>
      <display value="electronic form to follow"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="FAX"/>
      <display value="fax to follow"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="GFTH"/>
      <display value="good faith indicator"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="LATE"/>
      <display value="late invoice"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="MANUAL"/>
      <display value="manual review"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="OOJ"/>
      <display value="out of jurisdiction"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="ORTHO"/>
      <display value="orthodontic service"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="PAPER"/>
      <display value="paper documentation to follow"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="PIE"/>
      <display value="public insurance exhausted"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="PYRDELAY"/>
      <display value="delayed by a previous payor"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="REFNR"/>
      <display value="referral not required"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="REPSERV"/>
      <display value="repeated service"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="UNRELAT"/>
      <display value="unrelated service"/>
    </contains>
    <contains>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <version value="8.0.0"/>
      <code value="VERBAUTH"/>
      <display value="verbal authorization"/>
    </contains>
  </expansion>
</ValueSet>