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-CoverageEligibilityReason-for-R4 | Version: 0.0.1-snapshot-2 | |||
Standards status: Informative | Maturity Level: 0 | Computable Name: R5_v3_CoverageEligibilityReason_for_R4 |
This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-CoverageEligibilityReason | 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-ActReason
version 2.1.0
Code | Display | Definition |
AGE | age eligibility | A person becomes eligible for a program based on age. *Example:* In the U.S., a person who is 65 years of age or older is eligible for Medicare. |
CRIME | crime victim | A person becomes eligible for insurance or a program because of crime related health condition or injury. *Example:* A person is a claimant under the U.S. Crime Victims Compensation program. |
DIS | disability | A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization. |
EMPLOY | employment benefit | A person becomes eligible for insurance provided as an employment benefit based on employment status. |
FINAN | financial eligibility | A person becomes eligible for a program based on financial criteria. *Example:* A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP. |
HEALTH | health status | A person becomes eligible for a program because of a qualifying health condition or injury. *Examples:* A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program |
MULTI | multiple criteria eligibility | A person becomes eligible for a program based on more than one criterion. *Examples:* In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles. |
PNC | property and casualty condition | A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy. *Example:* A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises. |
STATUTORY | statutory eligibility | A person becomes eligible for a program based on statutory criteria. *Examples:* A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security. |
VEHIC | motor vehicle accident victim | A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury. |
WORK | work related | A person becomes eligible for insurance or a program because of a work related health condition or injury. *Example:* A person is a claimant under the U.S. Black Lung Program. |
This value set expansion contains 11 concepts.
Code | System | Display | Definition |
AGE | http://terminology.hl7.org/CodeSystem/v3-ActReason | age eligibility | A person becomes eligible for a program based on age. Example: In the U.S., a person who is 65 years of age or older is eligible for Medicare. |
CRIME | http://terminology.hl7.org/CodeSystem/v3-ActReason | crime victim | A person becomes eligible for insurance or a program because of crime related health condition or injury. Example: A person is a claimant under the U.S. Crime Victims Compensation program. |
DIS | http://terminology.hl7.org/CodeSystem/v3-ActReason | disability | A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization. |
EMPLOY | http://terminology.hl7.org/CodeSystem/v3-ActReason | employment benefit | A person becomes eligible for insurance provided as an employment benefit based on employment status. |
FINAN | http://terminology.hl7.org/CodeSystem/v3-ActReason | financial eligibility | A person becomes eligible for a program based on financial criteria. Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP. |
HEALTH | http://terminology.hl7.org/CodeSystem/v3-ActReason | health status | A person becomes eligible for a program because of a qualifying health condition or injury. Examples: A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program |
MULTI | http://terminology.hl7.org/CodeSystem/v3-ActReason | multiple criteria eligibility | A person becomes eligible for a program based on more than one criterion. Examples: In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles. |
PNC | http://terminology.hl7.org/CodeSystem/v3-ActReason | property and casualty condition | A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy. Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises. |
STATUTORY | http://terminology.hl7.org/CodeSystem/v3-ActReason | statutory eligibility | A person becomes eligible for a program based on statutory criteria. Examples: A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security. |
VEHIC | http://terminology.hl7.org/CodeSystem/v3-ActReason | motor vehicle accident victim | A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury. |
WORK | http://terminology.hl7.org/CodeSystem/v3-ActReason | work related | A person becomes eligible for insurance or a program because of a work related health condition or injury. Example: A person is a claimant under the U.S. Black Lung Program. |
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 |