Codesystem-insuranceplan-applicability.xml

Definition for Code System BenefitCostApplicability

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

<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="insuranceplan-applicability"/> 
  <meta> 
    <lastUpdated value="2019-12-31T21:03:40.621+11:00"/> 
    <profile value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/> 
  </meta> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">
      <h2> Benefit cost applicability</h2> 
      <div> 
        <p> Whether the cost applies to in-network or out-of-network providers.</p> 

      </div> 
      <p> This code system http://terminology.hl7.org/CodeSystem/applicability defines the following
         codes:</p> 
      <table class="codes">
        <tr> 
          <td style="white-space:nowrap">
            <b> Code</b> 
          </td> 
          <td> 
            <b> Display</b> 
          </td> 
          <td> 
            <b> Definition</b> 
          </td> 
        </tr> 
        <tr> 
          <td style="white-space:nowrap">in-network
            <a name="insuranceplan-applicability-in-network"> </a> 
          </td> 
          <td> In Network</td> 
          <td> Provider is contracted with the health insurance company to provide services to plan members
             for specific pre-negotiated rates</td> 
        </tr> 
        <tr> 
          <td style="white-space:nowrap">out-of-network
            <a name="insuranceplan-applicability-out-of-network"> </a> 
          </td> 
          <td> Out of Network</td> 
          <td> Provider is  not contracted with the health insurance company to provide services to plan
             members for specific pre-negotiated rates</td> 
        </tr> 
        <tr> 
          <td style="white-space:nowrap">other
            <a name="insuranceplan-applicability-other"> </a> 
          </td> 
          <td> Other</td> 
          <td> Other applicability</td> 
        </tr> 
      </table> 
    </div> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="pa"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="0"/> 
  </extension> 
  <url value="http://terminology.hl7.org/CodeSystem/applicability"/> 
  <identifier> 
    <system value="urn:ietf:rfc:3986"/> 
    <value value="urn:oid:2.16.840.1.113883.4.642.1.0"/> 
  </identifier> 
  <version value="4.2.0"/> 
  <name value="BenefitCostApplicability"/> 
  <title value="Benefit cost applicability"/> 
  <status value="draft"/> 
  <experimental value="false"/> 
  <date value="2018-06-05T14:06:02+00:00"/> 
  <publisher value="HL7 (FHIR Project)"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://hl7.org/fhir"/> 
    </telecom> 
    <telecom> 
      <system value="email"/> 
      <value value="fhir@lists.hl7.org"/> 
    </telecom> 
  </contact> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://hl7.org/fhir"/> 
    </telecom> 
    <telecom> 
      <system value="email"/> 
      <value value="fhir@lists.hl7.org"/> 
    </telecom> 
  </contact> 
  <description value="Whether the cost applies to in-network or out-of-network providers."/> 
  <caseSensitive value="true"/> 
  <valueSet value="http://hl7.org/fhir/ValueSet/insuranceplan-applicability"/> 
  <content value="complete"/> 
  <concept> 
    <code value="in-network"/> 
    <display value="In Network"/> 
    <definition value="Provider is contracted with the health insurance company to provide services to plan members
     for specific pre-negotiated rates"/> 
  </concept> 
  <concept> 
    <code value="out-of-network"/> 
    <display value="Out of Network"/> 
    <definition value="Provider is  not contracted with the health insurance company to provide services to plan
     members for specific pre-negotiated rates"/> 
  </concept> 
  <concept> 
    <code value="other"/> 
    <display value="Other"/> 
    <definition value="Other applicability"/> 
  </concept> 
</CodeSystem>