Release 5 Draft Ballot

This page is part of the FHIR Specification (v4.6.0: R5 Draft Ballot - see ballot notes). 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: R5 R4B R4

4.4.1.109 Value Set http://hl7.org/fhir/ValueSet/insuranceplan-applicability

Patient Administration Work Group Maturity Level: 0Trial Use Use Context: Any

This is a value set defined by the FHIR project.

Summary

Defining URL:http://hl7.org/fhir/ValueSet/insuranceplan-applicability
Version:4.6.0
Name:BenefitCostApplicability
Title:
Definition:

Whether the cost applies to in-network or out-of-network providers.

Committee:Patient Administration Work Group
OID:2.16.840.1.113883.4.642.3.0 (for OID based terminology systems)
Source ResourceXML / JSON

This value set is used in the following places:

4.4.1.109.1 Content Logical Definition

 

4.4.1.109.2 Expansion

This expansion generated 15 Apr 2021

This value set contains 3 concepts

Expansion based on Benefit cost applicability v0.1.0 (CodeSystem)

All codes from system http://terminology.hl7.org/CodeSystem/applicability

CodeDisplayDefinition
in-network In NetworkProvider is contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates
out-of-network Out of NetworkProvider is not contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates
other OtherOther applicability

 

See the full registry of value sets defined as part of FHIR.

Explanation of the columns that may appear on this page:

LvlA few code lists that FHIR defines are hierarchical - each code is assigned a level. For value sets, levels are mostly used to organize codes for user convenience, but may follow code system hierarchy - see Code System for further information
SourceThe source of the definition of the code (when the value set draws in codes defined elsewhere)
CodeThe code (used as the code in the resource instance). If the code is in italics, this indicates that the code is not selectable ('Abstract')
DisplayThe display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
DefinitionAn explanation of the meaning of the concept
CommentsAdditional notes about how to use the code