HL7 FHIR® Validated Healthcare Directory Implementation Guide STU 1

Validated Healthcare Directory, published by HL7 International - Patient Admistration Working Group. This is not an authorized publication; it is the continuous build for version 0.2.0). This version is based on the current content of https://github.com/HL7/VhDir/ and changes regularly. See the Directory of published versions

Defining URL:http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics
Version:0.2.0
Name:VhDirPayerCharacteristics
Title:VhDir Payer Characteristics Code System
Status:Active
Content:All the concepts defined by the code system are included in the code system resource
Definition:

This code system contains codes for documenting attributes of a Payor related resources.

Publisher:HL7 International
Source Resource:XML / JSON / Turtle

VhDir Payer Characteristics Code System

This code system contains codes for documenting attributes of a Payor related resources.

This code system http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics defines the following codes:

CodeDisplayDefinition
medical MedicalMedical insurance coverage.
dental DentalDental insurance coverage.
menthlth Mental HealthMental health insurance coverage.
substanceabuse Substance AbuseSubstance abuse services insurance coverage.
vision VisionVision insurance coverage.
drug DrugPrescription drug coverage.
stc Short Term CareShort term care.
ltc Long Term CareLong term care.
hospice HospiceHospice insurance coverage.
homehealth Home HealthHome health services insurance coverage.
dmepos DMEPOSDurable Medical Equipment, Prosthetics/Orthotics and Supplies.
imagingadv Advanced Imaging (CT/PET Scans, MRIs)Advances imaging techniques services (CT/PET Scans, MRIs) coverage.
rehab RehabilitationRehabilitation.
pcpov Primary Care Visit to Treat an Injury or IllnessBenefit plan covers services rendered by a primary care physician during an office visit with the purpose to treat injury or illness, except for preventive care services.
specialistov Specialist Office VisitCovered healthcare service rendered to a patient by a specialty provider.
mlpov Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level ProfessionalBenefit plan covers covered health related services rendered by a practioner other than MD or DO and referred to as other practitioner.
outpatient Outpatient Facility Fee (e.g., Ambulatory Surgery Center)Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission.
outpatstx Outpatient Surgery Physician/Surgical ServicesBenefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient.
hospserv Hospice ServicesBenefit plan covers hospice services.
routinedental Routine Dental Services (Adult)Benefit plan covers routine dental services.
infertilitytx Infertility TreatmentBenefit plan covers eligible infertility treatment services.
ltnhc Long-Term/Custodial Nursing Home CareLong-Term/Custodial Nursing Home Care.
privatenurse Private-Duty NursingPrivate-Duty Nursing.
routineeye Routine Eye Exam (Adult)Routine Eye Exam (Adult).
ucservice Urgent Care Centers or FacilitiesUrgent Care Centers or Facilities.
erservice Emergency Room ServicesEmergency Room Services.
ambulance Emergency Room ServicesEmergency Room Services.
inpatienthospital Inpatient Hospital Services (e.g., Hospital Stay)A person who is hospitalized for at least one night to receive treatment or participate in a study.
inpatientprovider Inpatient Physician and Surgical ServicesA healthcare provider who is delivering healthcare services in a hospital environment.
bariatricsurg Bariatric SurgeryBariatric surgery service Skilled nursing service (qualifier value).
cosmeticsurg Cosmetic SurgeryCosmetic surgery service Skilled nursing service (qualifier value).
skillednursing Skilled Nursing FacilitySkilled nursing service (qualifier value).
ppnatalcare Prenatal and Postnatal CarePrenatal and Postnatal services.
maternitycare Delivery and All Inpatient Services for Maternity CareAll maternity care services.
menthlthoutp Mental/Behavioral Health Outpatient ServicesMental health service delivered in an outpatient setting.
menthlthinp Mental/Behavioral Health Inpatient ServicesMental health service delivered in an hospital or inpatient facility setting.
sadoutp Substance Abuse Disorder Outpatient ServicesSubstance abuse related services delivered in a outpatient setting.
sadinp Substance Abuse Disorder Inpatient ServicesSubstance abuse related services delivered in a inpatient setting.
drggenric Generic DrugsGeneric drugs eligible benefits.
drgbrand Preferred Brand DrugsPreferred brand drugs eligible benefits.
drgnonpreferred Non-Preferred Brand DrugsNon-Preferred drugs brands eligible benefits.
drgspecialty Specialty DrugsBenefit plan covers specialty drugs.
rehaboutp Outpatient Rehabilitation ServicesBenefit plan covers outpatient rehabilitation services.
servicehablitation Habilitation ServicesHabilitation Services.
chiro Chiropractic CareBenefit plan covers chiropractor eligible benefits.
dme Durable Medical EquipmentBenefit plan covers Durable medical equipment eligible benefits.
hearingaids Hearing AidsBenefit plan covers hearing aids.
imgctpetmri Imaging (CT/PET Scans, MRIs)Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services.
prev Preventive Care/Screening/ImmunizationRoutine healthcare services to prevent health related problems eligible benefits.
rtnpod Routine Foot CareRoutine Foot Care.
acupuncture AcupunctureBenefit plan covers acupuncture treatment.
weightloss Weight Loss ProgramsBenefit plan covers weight loss services eligible benefits.
rtneyechld Routine Eye Exam for ChildrenRoutine eye exam for children eligible benefits.
glasseschld Eye Glasses for ChildrenEye glasses children eligible benefits.
rtndntlchld Dental Check-Up for ChildrenDental Check-Up for Children.
speachthpy Rehabilitative Speech TherapyBenefit plan covers rehabilitative speech therapy eligible benefits.
rehaboccandpt Rehabilitative Occupational and Rehabilitative Physical TherapyBenefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.
wellbaby Well Baby Visits and CareRegularly scheduled, preventive care services, including immunizations, provided to children up to an age as specified by a health insurance company or mandated by a government agency.
laboutp Laboratory Outpatient and Professional ServicesBenefit plan covers laboratory testing and related professional services received as outpatient.
imagingdx X-rays and Diagnostic ImagingBenefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases.
dntlbaschld Basic Dental Care – ChildBenefit plan covers diagnostic basic dental care.
orthochld Orthodontia – ChildBenefit plan covers orthodontia for children.
dntlmajchld Major Dental Care – ChildBenefit plan covers major dental care for children.
dntlbasadlt Basic Dental Care – AdultBenefit plan covers basic dental care for adults.
orthodadlt Orthodontia – AdultBenefits plan covers services provided that are required for orthodontic purposes for an adult.
dntlmajadlt Major Dental Care – AdultBenefit plan covers major dental care for adult.
abortion Abortion for Which Public Funding is ProhibitedBenefit plan covers services for abortion for which public funding is prohibited.
transplant TransplantBenefit plan covers transplant related services.
accdntl Accidental DentalBenefit plan covers dental care services related to an accident.
dialysis DialysisThe plan benefit covers services used to treat end stage renal disease.
testallrgy Allergy TestingThe plan benefits covers services for diagnostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge activities.
chemotherapy ChemotherapyThe plan benefits cover services the use of drugs and approved chemicals to treat disease.
radiation RadiationThe plan benefits cover services the use radiation to treat disease.
edudiab Diabetes EducationThe plan benefits cover services related to instruction or training that encourages behaviors most likely to optimize health potentials through information about diabetes; facilitates the prevention of diabetes.
prosthetic Prosthetic DevicesPlan benefit covers services related to prosthesis devices.
infusiontx Infusion TherapyPlan benefit covers services related to infusion therapy.
tmjtx Treatment for Temporomandibular Joint DisordersPlan benefit covers services related to treatment of Temporomandibular Joint disorder.
nutrition Nutritional CounselingNutritional Counseling.
reconsurg Reconstructive SurgeryPlan benefit covers services related to reconstructive surgery.
days DaysMeasure of service covered by the plan benefit expressed in a definite number of days.
visit VisitsMeasure of service covered by the plan benefit expressed in a definite number of visits.
procedure ProceduresMeasure of service covered by the plan benefit expressed in a set of actions covered.
admission AdmissionsMeasure of services covered by the benefit plan expressed in relation to patient's acceptance for medical and nursing care in a hospital or other health care institution.
visithrs Hours per visitMeasure expresses how many hours per visit are covered by the insurance benefit plan.
weekhrs Hours per weekMeasure expresses how many hours per week are covered by the insurance benefit plan.
mthhrs Hours per monthMeasure expressed how many hours per month are covered by the insurance benefit plan.
yrhrs Hours per yearMeasure expreses how many hours per year are covered by the insurance benfit plan.
daysperwk Days per weekMeasure of service covered by the plan benefit expressed in a how many days are covered in a week.
dayspermth Days per monthMeasure of service covered by the plan benefit expressed in a how many days are covered in a month.
daysperyr Days per yearMeasure of service covered by the plan benefit expressed in a how many days are covered in a year.
mthsperyr Months per yearMeasure of service covered by the plan benefit expressed in a how many month are covered in a year.
visitsperday Visits per dayMeasure of service covered by the plan benefit expressed in a definite number of visits covered per day.
visitsperweek Visits per weekMeasure of service covered by the plan benefit expressed in a definite number of visits covered per week.
visitspermth Visits per monthMeasure of service covered by the plan benefit expressed in a definite number of visits covered per month.
visitsperyr Visits per yearMeasure of service covered by the plan benefit expressed in a definite number of visits covered per year.
lifetimevisits Lifetime visitsMeasure of service covered by the plan benefit expressed in a definite number of visits covered through lifetime.
txperweek Treatments per weekMeasure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a week.
txpermnth Treatments per monthMeasure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a month.
txlifetime Lifetime treatmentsMeasure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a lifetime.
admitslifetime Lifetime admissionsMeasure of service covered by the plan benefit expressed in a definite number admission actions covered through lifetime.
procperwk Procedures per weekMeasure of service covered by the plan benefit expressed in a definite number procedure covered per week.
procpermnth Procedures per monthMeasure of service covered by the plan benefit expressed in a definite number procedure covered per month.
procperyr Procedures per yearMeasure of service covered by the plan benefit expressed in a definite number procedure covered per year.
proclifetime Lifetime proceduresMeasure of service covered by the plan benefit expressed in a definite number procedure covered per lifetime.
daysperadmission Days per admissionMeasure of service covered by the plan benefit expressed in a definite number of days covered for each individual admission.
procperepi Procedures per episodeMeasure of service covered by the plan benefit expressed in a definite number of procedures covered for each individual treatment episode.
cat Catastrophic'Catastrophic' health insurance plans have low monthly premiums and very high deductibles. They may cover worst-case scenarios, like getting seriously sick or injured. Patient pays most routine medical expenses.
bronze Bronze'Bronze' type plan defines the estimated split costs of the plan, where patient is responsible for 40% of their healthcare cost while 60% is covered by the plan.
bronzeexp Expanded BronzeThe 'extended bronze' plan is an addition to the bronze metal level which establishes the de minimis variation range for the actuarial value (AV) level of coverage to allow variation in the AV to -4/+2 percentage points.
silver Silver'Silver' type plan defines the estimated split costs of the plan, where patient is responsible for 30% of their healthcare cost while 70% is covered by the plan.
gold Gold'Gold' type plan defines the estimated split costs of the plan, where patient is responsible for 20% of their healthcare cost while 80% is covered by the plan.
platinum Platinum'Platinum' type plan defines the estimated split costs of the plan, where patient is responsible for 10% of their healthcare cost while 90% is covered by the plan.
lowded Low deductibleA health insurance plan with higher premiums and lower out of pocket cost than a traditional health plan.
highded High deductibleA health insurance plan with lower premiums and higher out of pocket cost than a traditional health plan.