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

: R5V3CoverageParticipationFunctionForR4 - XML Representation

Page standards status: Trial-use Maturity Level: 0

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="R5-v3-CoverageParticipationFunction-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-CoverageParticipationFunction-for-R4</b></p><a name="R5-v3-CoverageParticipationFunction-for-R4"> </a><a name="hcR5-v3-CoverageParticipationFunction-for-R4"> </a><p>This value set expansion contains 17 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></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-CLMADJ"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  CLMADJ</td><td>claims adjudication</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-ENROLL"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  ENROLL</td><td>enrollment broker</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-FFSMGT"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  FFSMGT</td><td>ffs management</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-FULINRD"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  FULINRD</td><td>fully insured</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-MCMGT"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  MCMGT</td><td>managed care management</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-PAYORCNTR"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  PAYORCNTR</td><td>payor contracting</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-PROVMGT"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  PROVMGT</td><td>provider management</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-REINS"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  REINS</td><td>reinsures</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-RETROCES"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  RETROCES</td><td>retrocessionaires</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-SELFINRD"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  SELFINRD</td><td>self insured</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-SUBCTRT"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  SUBCTRT</td><td>subcontracting risk</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-UMGT"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  UMGT</td><td>utilization management</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-UNDERWRTNG"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  UNDERWRTNG</td><td>underwriting</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-_CoverageParticipationFunction"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  _CoverageParticipationFunction</td><td>CoverageParticipationFunction</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-_PayorParticipationFunction"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  _PayorParticipationFunction</td><td>PayorParticipationFunction</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-_SponsorParticipationFunction"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  _SponsorParticipationFunction</td><td>SponsorParticipationFunction</td></tr><tr><td><a name="R5-v3-CoverageParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-_UnderwriterParticipationFunction"> </a><code>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</code></td><td>2.1.0</td><td style="white-space:nowrap">  _UnderwriterParticipationFunction</td><td>UnderwriterParticipationFunction</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-CoverageParticipationFunction-for-R4"/>
  <version value="0.1.0"/>
  <name value="R5V3CoverageParticipationFunctionForR4"/>
  <title
         value="Cross-version ValueSet R5.CoverageParticipationFunction 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-CoverageParticipationFunction|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-CoverageParticipationFunction|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-CoverageParticipationFunction|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-ParticipationFunction"/>
      <version value="2.1.0"/>
      <concept>
        <code value="CLMADJ"/>
        <display value="claims adjudication"/>
      </concept>
      <concept>
        <code value="ENROLL"/>
        <display value="enrollment broker"/>
      </concept>
      <concept>
        <code value="FFSMGT"/>
        <display value="ffs management"/>
      </concept>
      <concept>
        <code value="FULINRD"/>
        <display value="fully insured"/>
      </concept>
      <concept>
        <code value="MCMGT"/>
        <display value="managed care management"/>
      </concept>
      <concept>
        <code value="PAYORCNTR"/>
        <display value="payor contracting"/>
      </concept>
      <concept>
        <code value="PROVMGT"/>
        <display value="provider management"/>
      </concept>
      <concept>
        <code value="REINS"/>
        <display value="reinsures"/>
      </concept>
      <concept>
        <code value="RETROCES"/>
        <display value="retrocessionaires"/>
      </concept>
      <concept>
        <code value="SELFINRD"/>
        <display value="self insured"/>
      </concept>
      <concept>
        <code value="SUBCTRT"/>
        <display value="subcontracting risk"/>
      </concept>
      <concept>
        <code value="UMGT"/>
        <display value="utilization management"/>
      </concept>
      <concept>
        <code value="UNDERWRTNG"/>
        <display value="underwriting"/>
      </concept>
      <concept>
        <code value="_CoverageParticipationFunction"/>
        <display value="CoverageParticipationFunction"/>
      </concept>
      <concept>
        <code value="_PayorParticipationFunction"/>
        <display value="PayorParticipationFunction"/>
      </concept>
      <concept>
        <code value="_SponsorParticipationFunction"/>
        <display value="SponsorParticipationFunction"/>
      </concept>
      <concept>
        <code value="_UnderwriterParticipationFunction"/>
        <display value="UnderwriterParticipationFunction"/>
      </concept>
    </include>
  </compose>
  <expansion>
    <timestamp value="2026-03-17T21:02:03.8104715+00:00"/>
    <contains>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
      <version value="2.1.0"/>
      <code value="CLMADJ"/>
      <display value="claims adjudication"/>
    </contains>
    <contains>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
      <version value="2.1.0"/>
      <code value="ENROLL"/>
      <display value="enrollment broker"/>
    </contains>
    <contains>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
      <version value="2.1.0"/>
      <code value="FFSMGT"/>
      <display value="ffs management"/>
    </contains>
    <contains>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
      <version value="2.1.0"/>
      <code value="FULINRD"/>
      <display value="fully insured"/>
    </contains>
    <contains>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
      <version value="2.1.0"/>
      <code value="MCMGT"/>
      <display value="managed care management"/>
    </contains>
    <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="PROVMGT"/>
      <display value="provider management"/>
    </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="SELFINRD"/>
      <display value="self insured"/>
    </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="UMGT"/>
      <display value="utilization management"/>
    </contains>
    <contains>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
      <version value="2.1.0"/>
      <code value="UNDERWRTNG"/>
      <display value="underwriting"/>
    </contains>
    <contains>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
      <version value="2.1.0"/>
      <code value="_CoverageParticipationFunction"/>
      <display value="CoverageParticipationFunction"/>
    </contains>
    <contains>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
      <version value="2.1.0"/>
      <code value="_PayorParticipationFunction"/>
      <display value="PayorParticipationFunction"/>
    </contains>
    <contains>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
      <version value="2.1.0"/>
      <code value="_SponsorParticipationFunction"/>
      <display value="SponsorParticipationFunction"/>
    </contains>
    <contains>
      <system
              value="http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"/>
      <version value="2.1.0"/>
      <code value="_UnderwriterParticipationFunction"/>
      <display value="UnderwriterParticipationFunction"/>
    </contains>
  </expansion>
</ValueSet>