FHIR Cross-Version Extensions package for FHIR R4 from FHIR R5
0.0.1-snapshot-2 - informative International flag

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

: Cross-version VS for R5.PayorParticipationFunction for use in FHIR R4 - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:ValueSet ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "R5-v3-PayorParticipationFunction-for-R4"] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet R5-v3-PayorParticipationFunction-for-R4</b></p><a name=\"R5-v3-PayorParticipationFunction-for-R4\"> </a><a name=\"hcR5-v3-PayorParticipationFunction-for-R4\"> </a><p>This value set expansion contains 6 concepts.</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>System</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-PayorParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-CLMADJ\"> </a>  <a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ParticipationFunction.html#v3-ParticipationFunction-CLMADJ\">CLMADJ</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</td><td>claims adjudication</td><td><div><p><strong>Definition:</strong> Manages all operations required to adjudicate fee for service claims or managed care encounter reports.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-PayorParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-ENROLL\"> </a>  <a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ParticipationFunction.html#v3-ParticipationFunction-ENROLL\">ENROLL</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</td><td>enrollment broker</td><td><div><p><strong>Definition:</strong> Managing the enrollment of covered parties.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-PayorParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-FFSMGT\"> </a>  <a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ParticipationFunction.html#v3-ParticipationFunction-FFSMGT\">FFSMGT</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</td><td>ffs management</td><td><div><p><strong>Definition:</strong> Managing all operations required to administer a fee for service or indemnity health plan including enrolling covered parties and providing customer service, provider contracting, claims payment, care management and utilization review.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-PayorParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-MCMGT\"> </a>  <a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ParticipationFunction.html#v3-ParticipationFunction-MCMGT\">MCMGT</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</td><td>managed care management</td><td><div><p><strong>Definition:</strong> Managing all operations required to administer a managed care plan including enrolling covered parties and providing customer service,, provider contracting, claims payment, care management and utilization review.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-PayorParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-PROVMGT\"> </a>  <a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ParticipationFunction.html#v3-ParticipationFunction-PROVMGT\">PROVMGT</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</td><td>provider management</td><td><div><p><strong>Definition:</strong> Managing provider contracting, provider services, credentialing, profiling, performance measures, and ensuring network adequacy.</p>\n</div></td></tr><tr><td style=\"white-space:nowrap\"><a name=\"R5-v3-PayorParticipationFunction-for-R4-http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction-UMGT\"> </a>  <a href=\"http://terminology.hl7.org/6.5.0/CodeSystem-v3-ParticipationFunction.html#v3-ParticipationFunction-UMGT\">UMGT</a></td><td>http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction</td><td>utilization management</td><td><div><p><strong>Definition:</strong> Managing utilization of services by ensuring that providers adhere to, e.g., payeraTMs clinical protocols for medical appropriateness and standards of medical necessity. May include management of authorizations for services and referrals.</p>\n</div></td></tr></table></div>"^^rdf:XMLLiteral
  ] ; # 
  fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ;
fhir:value [
a fhir:code ;
fhir:v "fhir"     ]
  ] [
    ( fhir:extension [
fhir:url [ fhir:v "packageId"^^xsd:anyURI ] ;
fhir:value [
a fhir:id ;
fhir:v "hl7.fhir.uv.xver-r5.r4"       ]     ] [
fhir:url [ fhir:v "version"^^xsd:anyURI ] ;
fhir:value [
a fhir:string ;
fhir:v "0.0.1-snapshot-2"       ]     ] ) ;
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/package-source"^^xsd:anyURI ]
  ] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ] ;
fhir:value [
a fhir:integer ;
fhir:v 0 ;
      ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ] ;
fhir:value [
a fhir:canonical ;
fhir:v "http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4>         ]       ] )     ]
  ] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ] ;
fhir:value [
a fhir:code ;
fhir:v "informative" ;
      ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ] ;
fhir:value [
a fhir:canonical ;
fhir:v "http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4>         ]       ] )     ]
  ] ) ; # 
  fhir:url [ fhir:v "http://hl7.org/fhir/5.0/ValueSet/R5-v3-PayorParticipationFunction-for-R4"^^xsd:anyURI] ; # 
  fhir:version [ fhir:v "0.0.1-snapshot-2"] ; # 
  fhir:name [ fhir:v "R5_v3_PayorParticipationFunction_for_R4"] ; # 
  fhir:title [ fhir:v "Cross-version VS for R5.PayorParticipationFunction for use in FHIR R4"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:experimental [ fhir:v false] ; # 
  fhir:date [ fhir:v "2025-09-01T22:37:05.284195+10:00"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "FHIR Infrastructure"] ; # 
  fhir:contact ( [
fhir:name [ fhir:v "FHIR Infrastructure" ] ;
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fiwg" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-PayorParticipationFunction|2.0.0 for use in FHIR R4. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4."] ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "http://unstats.un.org/unsd/methods/m49/m49.htm"^^xsd:anyURI ] ;
fhir:code [ fhir:v "001" ] ;
fhir:display [ fhir:v "World" ]     ] )
  ] ) ; # 
  fhir:compose [
    ( fhir:include [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"^^xsd:anyURI ] ;
fhir:version [ fhir:v "2.1.0" ] ;
      ( fhir:concept [
fhir:code [ fhir:v "CLMADJ" ] ;
fhir:display [ fhir:v "claims adjudication" ]       ] [
fhir:code [ fhir:v "ENROLL" ] ;
fhir:display [ fhir:v "enrollment broker" ]       ] [
fhir:code [ fhir:v "FFSMGT" ] ;
fhir:display [ fhir:v "ffs management" ]       ] [
fhir:code [ fhir:v "MCMGT" ] ;
fhir:display [ fhir:v "managed care management" ]       ] [
fhir:code [ fhir:v "PROVMGT" ] ;
fhir:display [ fhir:v "provider management" ]       ] [
fhir:code [ fhir:v "UMGT" ] ;
fhir:display [ fhir:v "utilization management" ]       ] )     ] )
  ] ; # 
  fhir:expansion [
fhir:timestamp [ fhir:v "2025-09-01T22:37:05.284193+10:00"^^xsd:dateTime ] ;
    ( fhir:contains [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"^^xsd:anyURI ] ;
fhir:version [ fhir:v "2.1.0" ] ;
fhir:code [ fhir:v "CLMADJ" ] ;
fhir:display [ fhir:v "claims adjudication" ]     ] [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"^^xsd:anyURI ] ;
fhir:version [ fhir:v "2.1.0" ] ;
fhir:code [ fhir:v "ENROLL" ] ;
fhir:display [ fhir:v "enrollment broker" ]     ] [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"^^xsd:anyURI ] ;
fhir:version [ fhir:v "2.1.0" ] ;
fhir:code [ fhir:v "FFSMGT" ] ;
fhir:display [ fhir:v "ffs management" ]     ] [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"^^xsd:anyURI ] ;
fhir:version [ fhir:v "2.1.0" ] ;
fhir:code [ fhir:v "MCMGT" ] ;
fhir:display [ fhir:v "managed care management" ]     ] [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"^^xsd:anyURI ] ;
fhir:version [ fhir:v "2.1.0" ] ;
fhir:code [ fhir:v "PROVMGT" ] ;
fhir:display [ fhir:v "provider management" ]     ] [
fhir:system [ fhir:v "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction"^^xsd:anyURI ] ;
fhir:version [ fhir:v "2.1.0" ] ;
fhir:code [ fhir:v "UMGT" ] ;
fhir:display [ fhir:v "utilization management" ]     ] )
  ] . #