This page is part of the FHIR Specification (v4.1.0: Release 4B Ballot #1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R4B R4
Patient Administration Work Group | Maturity Level: N/A | Standards Status: Informative |
Raw XML (canonical form + also see XML Format Specification)
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="2021-03-11T17:06:20.662+11:00"/> <profile value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/> </meta> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <p> This code system http://hl7.org/fhir/insuranceplan-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> <url value="http://hl7.org/fhir/insuranceplan-applicability"/> <identifier> <system value="urn:ietf:rfc:3986"/> <value value="urn:oid:2.16.840.1.113883.4.642.1.0"/> </identifier> <version value="4.1.0"/> <name value="BenefitCostApplicability"/> <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> <description value="Whether the cost applies to in-network or out-of-network providers."/> <caseSensitive value="true"/> <valueSet value="http://hl7.org/fhir/ValueSet/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>
Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.