FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 - Version 0.0.1-snapshot-2. See the Directory of published versions
Official URL: http://hl7.org/fhir/5.0/ValueSet/R5-v3-ActInvoiceOverrideCode-for-R4 | Version: 0.0.1-snapshot-2 | |||
Standards status: Informative | Maturity Level: 0 | Computable Name: R5_v3_ActInvoiceOverrideCode_for_R4 |
This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-ActInvoiceOverrideCode | 2.0.0 for use in FHIR R4. Concepts not present here have direct equivalent mappings crossing all versions from R5 to R4. |
References
This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)
http://terminology.hl7.org/CodeSystem/v3-ActCode
version 8.0.0
Code | Display | Definition |
COVGE | coverage problem | Insurance coverage problems have been encountered. Additional explanation information to be supplied. |
EFORM | electronic form to follow | Electronic form with supporting or additional information to follow. |
FAX | fax to follow | Fax with supporting or additional information to follow. |
GFTH | good faith indicator | The medical service was provided to a patient in good faith that they had medical coverage, although no evidence of coverage was available before service was rendered. |
LATE | late invoice | Knowingly over the payor's published time limit for this invoice possibly due to a previous payor's delays in processing. Additional reason information will be supplied. |
MANUAL | manual review | Manual review of the invoice is requested. Additional information to be supplied. This may be used in the case of an appeal. |
OOJ | out of jurisdiction | The medical service and/or product was provided to a patient that has coverage in another jurisdiction. |
ORTHO | orthodontic service | The service provided is required for orthodontic purposes. If the covered party has orthodontic coverage, then the service may be paid. |
PAPER | paper documentation to follow | Paper documentation (or other physical format) with supporting or additional information to follow. |
PIE | public insurance exhausted | Public Insurance has been exhausted. Invoice has not been sent to Public Insuror and therefore no Explanation Of Benefits (EOB) is provided with this Invoice submission. |
PYRDELAY | delayed by a previous payor | Allows provider to explain lateness of invoice to a subsequent payor. |
REFNR | referral not required | Rules of practice do not require a physician's referral for the provider to perform a billable service. |
REPSERV | repeated service | The same service was delivered within a time period that would usually indicate a duplicate billing. However, the repeated service is a medical necessity and therefore not a duplicate. |
UNRELAT | unrelated service | The service provided is not related to another billed service. For example, 2 unrelated services provided on the same day to the same patient which may normally result in a refused payment for one of the items. |
VERBAUTH | verbal authorization | The provider has received a verbal permission from an authoritative source to perform the service or supply the item being invoiced. |
This value set expansion contains 15 concepts.
Code | System | Display | Definition |
COVGE | http://terminology.hl7.org/CodeSystem/v3-ActCode | coverage problem | Insurance coverage problems have been encountered. Additional explanation information to be supplied. |
EFORM | http://terminology.hl7.org/CodeSystem/v3-ActCode | electronic form to follow | Electronic form with supporting or additional information to follow. |
FAX | http://terminology.hl7.org/CodeSystem/v3-ActCode | fax to follow | Fax with supporting or additional information to follow. |
GFTH | http://terminology.hl7.org/CodeSystem/v3-ActCode | good faith indicator | The medical service was provided to a patient in good faith that they had medical coverage, although no evidence of coverage was available before service was rendered. |
LATE | http://terminology.hl7.org/CodeSystem/v3-ActCode | late invoice | Knowingly over the payor's published time limit for this invoice possibly due to a previous payor's delays in processing. Additional reason information will be supplied. |
MANUAL | http://terminology.hl7.org/CodeSystem/v3-ActCode | manual review | Manual review of the invoice is requested. Additional information to be supplied. This may be used in the case of an appeal. |
OOJ | http://terminology.hl7.org/CodeSystem/v3-ActCode | out of jurisdiction | The medical service and/or product was provided to a patient that has coverage in another jurisdiction. |
ORTHO | http://terminology.hl7.org/CodeSystem/v3-ActCode | orthodontic service | The service provided is required for orthodontic purposes. If the covered party has orthodontic coverage, then the service may be paid. |
PAPER | http://terminology.hl7.org/CodeSystem/v3-ActCode | paper documentation to follow | Paper documentation (or other physical format) with supporting or additional information to follow. |
PIE | http://terminology.hl7.org/CodeSystem/v3-ActCode | public insurance exhausted | Public Insurance has been exhausted. Invoice has not been sent to Public Insuror and therefore no Explanation Of Benefits (EOB) is provided with this Invoice submission. |
PYRDELAY | http://terminology.hl7.org/CodeSystem/v3-ActCode | delayed by a previous payor | Allows provider to explain lateness of invoice to a subsequent payor. |
REFNR | http://terminology.hl7.org/CodeSystem/v3-ActCode | referral not required | Rules of practice do not require a physician's referral for the provider to perform a billable service. |
REPSERV | http://terminology.hl7.org/CodeSystem/v3-ActCode | repeated service | The same service was delivered within a time period that would usually indicate a duplicate billing. However, the repeated service is a medical necessity and therefore not a duplicate. |
UNRELAT | http://terminology.hl7.org/CodeSystem/v3-ActCode | unrelated service | The service provided is not related to another billed service. For example, 2 unrelated services provided on the same day to the same patient which may normally result in a refused payment for one of the items. |
VERBAUTH | http://terminology.hl7.org/CodeSystem/v3-ActCode | verbal authorization | The provider has received a verbal permission from an authoritative source to perform the service or supply the item being invoiced. |
Explanation of the columns that may appear on this page:
Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies |
System | The source of the definition of the code (when the value set draws in codes defined elsewhere) |
Code | The code (used as the code in the resource instance) |
Display | The 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 |
Definition | An explanation of the meaning of the concept |
Comments | Additional notes about how to use the code |