Validated Healthcare Directory
0.2.0 - CI Build

Validated Healthcare Directory, published by HL7 International - Patient Administration Work 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

ValueSet: VhDir Benefit Type

Summary

Defining URL:http://hl7.org/fhir/uv/vhdir/ValueSet/benefit-type
Version:0.2.0
Name:VhDirBenefitType
Title:VhDir Benefit Type
Status:Active as of 2018-02-21
Definition:

This value set defines a set of codes that indicate the type of benefit in a product/plan.

Publisher:HL7 International - Patient Administration Work Group
Copyright:

Used by permission of HL7 International all rights reserved Creative Commons License

Source Resource:XML / JSON / Turtle

References

Logical Definition (CLD)

  • Include these codes as defined in http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics
    CodeDisplayDefinition
    pcpovPrimary 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.
    specialistovSpecialist Office VisitCovered healthcare service rendered to a patient by a specialty provider.
    mlpovOther 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.
    outpatientOutpatient 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.
    outpatstxOutpatient Surgery Physician/Surgical ServicesBenefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient.
    hospservHospice ServicesBenefit plan covers hospice services.
    routinedentalRoutine Dental Services (Adult)Benefit plan covers routine dental services.
    infertilitytxInfertility TreatmentBenefit plan covers eligible infertility treatment services.
    ltnhcLong-Term/Custodial Nursing Home CareLong-Term/Custodial Nursing Home Care.
    privatenursePrivate-Duty NursingPrivate-Duty Nursing.
    routineeyeRoutine Eye Exam (Adult)Routine Eye Exam (Adult).
    ucserviceUrgent Care Centers or FacilitiesUrgent Care Centers or Facilities.
    homehealthHome HealthHome health services insurance coverage.
    erserviceEmergency Room ServicesEmergency Room Services.
    ambulanceEmergency Room ServicesEmergency Room Services.
    inpatienthospitalInpatient Hospital Services (e.g., Hospital Stay)A person who is hospitalized for at least one night to receive treatment or participate in a study.
    inpatientproviderInpatient Physician and Surgical ServicesA healthcare provider who is delivering healthcare services in a hospital environment.
    bariatricsurgBariatric SurgeryBariatric surgery service Skilled nursing service (qualifier value).
    cosmeticsurgCosmetic SurgeryCosmetic surgery service Skilled nursing service (qualifier value).
    skillednursingSkilled Nursing FacilitySkilled nursing service (qualifier value).
    ppnatalcarePrenatal and Postnatal CarePrenatal and Postnatal services.
    maternitycareDelivery and All Inpatient Services for Maternity CareAll maternity care services.
    menthlthoutpMental/Behavioral Health Outpatient ServicesMental health service delivered in an outpatient setting.
    menthlthinpMental/Behavioral Health Inpatient ServicesMental health service delivered in an hospital or inpatient facility setting.
    sadoutpSubstance Abuse Disorder Outpatient ServicesSubstance abuse related services delivered in a outpatient setting.
    sadinpSubstance Abuse Disorder Inpatient ServicesSubstance abuse related services delivered in a inpatient setting.
    drggenricGeneric DrugsGeneric drugs eligible benefits.
    drgbrandPreferred Brand DrugsPreferred brand drugs eligible benefits.
    drgnonpreferredNon-Preferred Brand DrugsNon-Preferred drugs brands eligible benefits.
    drgspecialtySpecialty DrugsBenefit plan covers specialty drugs.
    rehaboutpOutpatient Rehabilitation ServicesBenefit plan covers outpatient rehabilitation services.
    servicehablitationHabilitation ServicesHabilitation Services.
    chiroChiropractic CareBenefit plan covers chiropractor eligible benefits.
    dmeDurable Medical EquipmentBenefit plan covers Durable medical equipment eligible benefits.
    hearingaidsHearing AidsBenefit plan covers hearing aids.
    imgctpetmriImaging (CT/PET Scans, MRIs)Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services.
    prevPreventive Care/Screening/ImmunizationRoutine healthcare services to prevent health related problems eligible benefits.
    rtnpodRoutine Foot CareRoutine Foot Care.
    acupunctureAcupunctureBenefit plan covers acupuncture treatment.
    weightlossWeight Loss ProgramsBenefit plan covers weight loss services eligible benefits.
    rtneyechldRoutine Eye Exam for ChildrenRoutine eye exam for children eligible benefits.
    glasseschldEye Glasses for ChildrenEye glasses children eligible benefits.
    rtndntlchldDental Check-Up for ChildrenDental Check-Up for Children.
    speachthpyRehabilitative Speech TherapyBenefit plan covers rehabilitative speech therapy eligible benefits.
    rehaboccandptRehabilitative Occupational and Rehabilitative Physical TherapyBenefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.
    wellbabyWell 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.
    laboutpLaboratory Outpatient and Professional ServicesBenefit plan covers laboratory testing and related professional services received as outpatient.
    imagingdxX-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.
    dntlbaschldBasic Dental Care – ChildBenefit plan covers diagnostic basic dental care.
    orthochldOrthodontia – ChildBenefit plan covers orthodontia for children.
    dntlmajchldMajor Dental Care – ChildBenefit plan covers major dental care for children.
    dntlbasadltBasic Dental Care – AdultBenefit plan covers basic dental care for adults.
    orthodadltOrthodontia – AdultBenefits plan covers services provided that are required for orthodontic purposes for an adult.
    dntlmajadltMajor Dental Care – AdultBenefit plan covers major dental care for adult.
    abortionAbortion for Which Public Funding is ProhibitedBenefit plan covers services for abortion for which public funding is prohibited.
    transplantTransplantBenefit plan covers transplant related services.
    accdntlAccidental DentalBenefit plan covers dental care services related to an accident.
    dialysisDialysisThe plan benefit covers services used to treat end stage renal disease.
    testallrgyAllergy 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.
    chemotherapyChemotherapyThe plan benefits cover services the use of drugs and approved chemicals to treat disease.
    radiationRadiationThe plan benefits cover services the use radiation to treat disease.
    edudiabDiabetes 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.
    prostheticProsthetic DevicesPlan benefit covers services related to prosthesis devices.
    infusiontxInfusion TherapyPlan benefit covers services related to infusion therapy.
    tmjtxTreatment for Temporomandibular Joint DisordersPlan benefit covers services related to treatment of Temporomandibular Joint disorder.
    nutritionNutritional CounselingNutritional Counseling.
    reconsurgReconstructive SurgeryPlan benefit covers services related to reconstructive surgery.

 

Expansion

This value set contains 67 concepts

Expansion based on VhDir Payer Characteristics Code System v0.2.0 (CodeSystem)

All codes in this table are from the system http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics

CodeDisplayDefinition
pcpovPrimary 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.
specialistovSpecialist Office VisitCovered healthcare service rendered to a patient by a specialty provider.
mlpovOther 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.
outpatientOutpatient 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.
outpatstxOutpatient Surgery Physician/Surgical ServicesBenefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient.
hospservHospice ServicesBenefit plan covers hospice services.
routinedentalRoutine Dental Services (Adult)Benefit plan covers routine dental services.
infertilitytxInfertility TreatmentBenefit plan covers eligible infertility treatment services.
ltnhcLong-Term/Custodial Nursing Home CareLong-Term/Custodial Nursing Home Care.
privatenursePrivate-Duty NursingPrivate-Duty Nursing.
routineeyeRoutine Eye Exam (Adult)Routine Eye Exam (Adult).
ucserviceUrgent Care Centers or FacilitiesUrgent Care Centers or Facilities.
homehealthHome HealthHome health services insurance coverage.
erserviceEmergency Room ServicesEmergency Room Services.
ambulanceEmergency Room ServicesEmergency Room Services.
inpatienthospitalInpatient Hospital Services (e.g., Hospital Stay)A person who is hospitalized for at least one night to receive treatment or participate in a study.
inpatientproviderInpatient Physician and Surgical ServicesA healthcare provider who is delivering healthcare services in a hospital environment.
bariatricsurgBariatric SurgeryBariatric surgery service Skilled nursing service (qualifier value).
cosmeticsurgCosmetic SurgeryCosmetic surgery service Skilled nursing service (qualifier value).
skillednursingSkilled Nursing FacilitySkilled nursing service (qualifier value).
ppnatalcarePrenatal and Postnatal CarePrenatal and Postnatal services.
maternitycareDelivery and All Inpatient Services for Maternity CareAll maternity care services.
menthlthoutpMental/Behavioral Health Outpatient ServicesMental health service delivered in an outpatient setting.
menthlthinpMental/Behavioral Health Inpatient ServicesMental health service delivered in an hospital or inpatient facility setting.
sadoutpSubstance Abuse Disorder Outpatient ServicesSubstance abuse related services delivered in a outpatient setting.
sadinpSubstance Abuse Disorder Inpatient ServicesSubstance abuse related services delivered in a inpatient setting.
drggenricGeneric DrugsGeneric drugs eligible benefits.
drgbrandPreferred Brand DrugsPreferred brand drugs eligible benefits.
drgnonpreferredNon-Preferred Brand DrugsNon-Preferred drugs brands eligible benefits.
drgspecialtySpecialty DrugsBenefit plan covers specialty drugs.
rehaboutpOutpatient Rehabilitation ServicesBenefit plan covers outpatient rehabilitation services.
servicehablitationHabilitation ServicesHabilitation Services.
chiroChiropractic CareBenefit plan covers chiropractor eligible benefits.
dmeDurable Medical EquipmentBenefit plan covers Durable medical equipment eligible benefits.
hearingaidsHearing AidsBenefit plan covers hearing aids.
imgctpetmriImaging (CT/PET Scans, MRIs)Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services.
prevPreventive Care/Screening/ImmunizationRoutine healthcare services to prevent health related problems eligible benefits.
rtnpodRoutine Foot CareRoutine Foot Care.
acupunctureAcupunctureBenefit plan covers acupuncture treatment.
weightlossWeight Loss ProgramsBenefit plan covers weight loss services eligible benefits.
rtneyechldRoutine Eye Exam for ChildrenRoutine eye exam for children eligible benefits.
glasseschldEye Glasses for ChildrenEye glasses children eligible benefits.
rtndntlchldDental Check-Up for ChildrenDental Check-Up for Children.
speachthpyRehabilitative Speech TherapyBenefit plan covers rehabilitative speech therapy eligible benefits.
rehaboccandptRehabilitative Occupational and Rehabilitative Physical TherapyBenefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.
wellbabyWell 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.
laboutpLaboratory Outpatient and Professional ServicesBenefit plan covers laboratory testing and related professional services received as outpatient.
imagingdxX-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.
dntlbaschldBasic Dental Care – ChildBenefit plan covers diagnostic basic dental care.
orthochldOrthodontia – ChildBenefit plan covers orthodontia for children.
dntlmajchldMajor Dental Care – ChildBenefit plan covers major dental care for children.
dntlbasadltBasic Dental Care – AdultBenefit plan covers basic dental care for adults.
orthodadltOrthodontia – AdultBenefits plan covers services provided that are required for orthodontic purposes for an adult.
dntlmajadltMajor Dental Care – AdultBenefit plan covers major dental care for adult.
abortionAbortion for Which Public Funding is ProhibitedBenefit plan covers services for abortion for which public funding is prohibited.
transplantTransplantBenefit plan covers transplant related services.
accdntlAccidental DentalBenefit plan covers dental care services related to an accident.
dialysisDialysisThe plan benefit covers services used to treat end stage renal disease.
testallrgyAllergy 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.
chemotherapyChemotherapyThe plan benefits cover services the use of drugs and approved chemicals to treat disease.
radiationRadiationThe plan benefits cover services the use radiation to treat disease.
edudiabDiabetes 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.
prostheticProsthetic DevicesPlan benefit covers services related to prosthesis devices.
infusiontxInfusion TherapyPlan benefit covers services related to infusion therapy.
tmjtxTreatment for Temporomandibular Joint DisordersPlan benefit covers services related to treatment of Temporomandibular Joint disorder.
nutritionNutritional CounselingNutritional Counseling.
reconsurgReconstructive SurgeryPlan benefit covers services related to reconstructive surgery.

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
Source 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