FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5
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FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5 - Version 0.0.1-snapshot-2. See the Directory of published versions

ValueSet: Cross-version VS for R5.EligibilityActReasonCode for use in FHIR R4

Official URL: http://hl7.org/fhir/5.0/ValueSet/R5-v3-EligibilityActReasonCode-for-R4 Version: 0.0.1-snapshot-2
Standards status: Informative Maturity Level: 0 Computable Name: R5_v3_EligibilityActReasonCode_for_R4

This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-EligibilityActReasonCode 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)

Logical Definition (CLD)

  • Include these codes as defined in http://terminology.hl7.org/CodeSystem/v3-ActReason version 2.1.0
    CodeDisplayDefinition
    COVSUScoverage suspendedWhen a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated to original start date upon proof of identification, residency etc.

    Example: Coverage may be suspended during a strike situation, when employer benefits for employees are not covered (i.e. not in effect).
    DECSDdeceasedClient deceased.
    REGERRregistered in errorClient was registered in error.
    AGEage eligibilityA 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.
    CRIMEcrime victimA 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.
    DISdisabilityA 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.
    EMPLOYemployment benefitA person becomes eligible for insurance provided as an employment benefit based on employment status.
    FINANfinancial eligibilityA 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.
    HEALTHhealth statusA 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
    MULTImultiple criteria eligibilityA 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.
    PNCproperty and casualty conditionA 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.
    STATUTORYstatutory eligibilityA 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.
    VEHICmotor vehicle accident victimA person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury.
    WORKwork relatedA 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.

 

Expansion

This value set expansion contains 14 concepts.

CodeSystemDisplayDefinition
  COVSUShttp://terminology.hl7.org/CodeSystem/v3-ActReasoncoverage suspended

When a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated to original start date upon proof of identification, residency etc.

Example: Coverage may be suspended during a strike situation, when employer benefits for employees are not covered (i.e. not in effect).

  DECSDhttp://terminology.hl7.org/CodeSystem/v3-ActReasondeceased

Client deceased.

  REGERRhttp://terminology.hl7.org/CodeSystem/v3-ActReasonregistered in error

Client was registered in error.

  AGEhttp://terminology.hl7.org/CodeSystem/v3-ActReasonage 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.

  CRIMEhttp://terminology.hl7.org/CodeSystem/v3-ActReasoncrime 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.

  DIShttp://terminology.hl7.org/CodeSystem/v3-ActReasondisability

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.

  EMPLOYhttp://terminology.hl7.org/CodeSystem/v3-ActReasonemployment benefit

A person becomes eligible for insurance provided as an employment benefit based on employment status.

  FINANhttp://terminology.hl7.org/CodeSystem/v3-ActReasonfinancial 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.

  HEALTHhttp://terminology.hl7.org/CodeSystem/v3-ActReasonhealth 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

  MULTIhttp://terminology.hl7.org/CodeSystem/v3-ActReasonmultiple 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.

  PNChttp://terminology.hl7.org/CodeSystem/v3-ActReasonproperty 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.

  STATUTORYhttp://terminology.hl7.org/CodeSystem/v3-ActReasonstatutory 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.

  VEHIChttp://terminology.hl7.org/CodeSystem/v3-ActReasonmotor 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.

  WORKhttp://terminology.hl7.org/CodeSystem/v3-ActReasonwork 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