<?xml version="1.0" encoding="UTF-8"?>

<ValueSet xmlns="http://hl7.org/fhir">
  <id value="R5-v3-UnderwriterParticipationFunction-for-R4B"/>
  <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-R4B</b></p><a name="R5-v3-UnderwriterParticipationFunction-for-R4B"> </a><a name="hcR5-v3-UnderwriterParticipationFunction-for-R4B"> </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-R4B-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-R4B-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-R4B-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-R4B-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-R4B-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"/>
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/package-source">
    <extension url="packageId">
      <valueId value="hl7.fhir.uv.xver-r5.r4b"/>
    </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.r4b"/>
      </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/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4b"/>
      </extension>
    </valueCode>
  </extension>
  <url value="http://hl7.org/fhir/5.0/ValueSet/R5-v3-UnderwriterParticipationFunction-for-R4B"/>
  <version value="0.0.1-snapshot-2"/>
  <name value="R5_v3_UnderwriterParticipationFunction_for_R4B"/>
  <title value="Cross-version VS for R5.UnderwriterParticipationFunction for use in FHIR R4B"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2025-09-01T22:37:05.474731+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 R4B. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4B."/>
  <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-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>