National Directory of Healthcare Providers & Services (NDH) Implementation Guide
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National Directory of Healthcare Providers & Services (NDH) Implementation Guide, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-ndh/ and changes regularly. See the Directory of published versions

CodeSystem: NDH Payer Characteristics Code System

Official URL: http://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCS Version: 1.0.0-ballot
Active as of 2024-06-17 Computable Name: NdhPayerCharacteristicsCS

NDH Payer Characteristics

This Code system is referenced in the content logical definition of the following value sets:

This case-sensitive code system http://hl7.org/fhir/us/ndh/CodeSystem/NdhPayerCharacteristicsCS defines the following codes:

CodeDisplayDefinition
medical Medical Medical insurance coverage.
dental Dental Dental insurance coverage.
menthlth Mental Health Mental health insurance coverage.
substanceabuse Substance Abuse Substance abuse services insurance coverage.
vision Vision Vision insurance coverage.
drug Drug Prescription drug coverage.
stc Short Term Care Short term care.
ltc Long Term Care Long term care.
hospice Hospice Hospice insurance coverage.
homehealth Home Health Home health services insurance coverage.
dmepos DMEPOS Durable Medical Equipment, Prosthetics/Orthotics and Supplies.
imagingadv Advanced Imaging (CT/PET Scans, MRIs) Advances imaging techniques services (CT/PET Scans, MRIs) coverage.
rehab Rehabilitation Rehabilitation.
pcpov Primary Care Visit to Treat an Injury or Illness Benefit 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 Visit Covered healthcare service rendered to a patient by a specialty provider.
mlpov Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional Benefit 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 Services Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient.
hospserv Hospice Services Benefit plan covers hospice services.
routinedental Routine Dental Services (Adult) Benefit plan covers routine dental services.
infertilitytx Infertility Treatment Benefit plan covers eligible infertility treatment services.
ltnhc Long-Term/Custodial Nursing Home Care Long-Term/Custodial Nursing Home Care.
privatenurse Private-Duty Nursing Private-Duty Nursing.
routineeye Routine Eye Exam (Adult) Routine Eye Exam (Adult).
ucservice Urgent Care Centers or Facilities Urgent Care Centers or Facilities.
erservice Emergency Room Services Emergency Room Services.
ambulance Emergency Room Services Emergency 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 Services A healthcare provider who is delivering healthcare services in a hospital environment.
bariatricsurg Bariatric Surgery Bariatric surgery service Skilled nursing service (qualifier value).
cosmeticsurg Cosmetic Surgery Cosmetic surgery service Skilled nursing service (qualifier value).
skillednursing Skilled Nursing Facility Skilled nursing service (qualifier value).
ppnatalcare Prenatal and Postnatal Care Prenatal and Postnatal services.
maternitycare Delivery and All Inpatient Services for Maternity Care All maternity care services.
menthlthoutp Mental/Behavioral Health Outpatient Services Mental health service delivered in an outpatient setting.
menthlthinp Mental/Behavioral Health Inpatient Services Mental health service delivered in an hospital or inpatient facility setting.
sadoutp Substance Abuse Disorder Outpatient Services Substance abuse related services delivered in a outpatient setting.
sadinp Substance Abuse Disorder Inpatient Services Substance abuse related services delivered in a inpatient setting.
drggenric Generic Drugs Generic drugs eligible benefits.
drgbrand Preferred Brand Drugs Preferred brand drugs eligible benefits.
drgnonpreferred Non-Preferred Brand Drugs Non-Preferred drugs brands eligible benefits.
drgspecialty Specialty Drugs Benefit plan covers specialty drugs.
rehaboutp Outpatient Rehabilitation Services Benefit plan covers outpatient rehabilitation services.
servicehablitation Habilitation Services Habilitation Services.
chiro Chiropractic Care Benefit plan covers chiropractor eligible benefits.
dme Durable Medical Equipment Benefit plan covers Durable medical equipment eligible benefits.
hearingaids Hearing Aids Benefit 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/Immunization Routine healthcare services to prevent health related problems eligible benefits.
rtnpod Routine Foot Care Routine Foot Care.
acupuncture Acupuncture Benefit plan covers acupuncture treatment.
weightloss Weight Loss Programs Benefit plan covers weight loss services eligible benefits.
rtneyechld Routine Eye Exam for Children Routine eye exam for children eligible benefits.
glasseschld Eye Glasses for Children Eye glasses children eligible benefits.
rtndntlchld Dental Check-Up for Children Dental Check-Up for Children.
speachthpy Rehabilitative Speech Therapy Benefit plan covers rehabilitative speech therapy eligible benefits.
rehaboccandpt Rehabilitative Occupational and Rehabilitative Physical Therapy Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.
wellbaby Well Baby Visits and Care Regularly 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 Services Benefit plan covers laboratory testing and related professional services received as outpatient.
imagingdx X-rays and Diagnostic Imaging Benefit 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 - Child Benefit plan covers diagnostic basic dental care.
orthochld Orthodontia - Child Benefit plan covers orthodontia for children.
dntlmajchld Major Dental Care - Child Benefit plan covers major dental care for children.
dntlbasadlt Basic Dental Care - Adult Benefit plan covers basic dental care for adults.
orthodadlt Orthodontia - Adult Benefits plan covers services provided that are required for orthodontic purposes for an adult.
dntlmajadlt Major Dental Care - Adult Benefit plan covers major dental care for adult.
abortion Abortion for Which Public Funding is Prohibited Benefit plan covers services for abortion for which public funding is prohibited.
transplant Transplant Benefit plan covers transplant related services.
accdntl Accidental Dental Benefit plan covers dental care services related to an accident.
dialysis Dialysis The plan benefit covers services used to treat end stage renal disease.
testallrgy Allergy Testing The 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 Chemotherapy The plan benefits cover services the use of drugs and approved chemicals to treat disease.
radiation Radiation The plan benefits cover services the use radiation to treat disease.
edudiab Diabetes Education The 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 Devices Plan benefit covers services related to prosthesis devices.
infusiontx Infusion Therapy Plan benefit covers services related to infusion therapy.
tmjtx Treatment for Temporomandibular Joint Disorders Plan benefit covers services related to treatment of Temporomandibular Joint disorder.
nutrition Nutritional Counseling Nutritional Counseling.
reconsurg Reconstructive Surgery Plan benefit covers services related to reconstructive surgery.
days Days Measure of service covered by the plan benefit expressed in a definite number of days.
visit Visits Measure of service covered by the plan benefit expressed in a definite number of visits.
procedure Procedures Measure of service covered by the plan benefit expressed in a set of actions covered.
admission Admissions Measure 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 visit Measure expresses how many hours per visit are covered by the insurance benefit plan.
weekhrs Hours per week Measure expresses how many hours per week are covered by the insurance benefit plan.
mthhrs Hours per month Measure expressed how many hours per month are covered by the insurance benefit plan.
yrhrs Hours per year Measure expreses how many hours per year are covered by the insurance benfit plan.
daysperwk Days per week Measure of service covered by the plan benefit expressed in a how many days are covered in a week.
dayspermth Days per month Measure of service covered by the plan benefit expressed in a how many days are covered in a month.
daysperyr Days per year Measure of service covered by the plan benefit expressed in a how many days are covered in a year.
mthsperyr Months per year Measure of service covered by the plan benefit expressed in a how many month are covered in a year.
visitsperday Visits per day Measure of service covered by the plan benefit expressed in a definite number of visits covered per day.
visitsperweek Visits per week Measure of service covered by the plan benefit expressed in a definite number of visits covered per week.
visitspermth Visits per month Measure of service covered by the plan benefit expressed in a definite number of visits covered per month.
visitsperyr Visits per year Measure of service covered by the plan benefit expressed in a definite number of visits covered per year.
lifetimevisits Lifetime visits Measure of service covered by the plan benefit expressed in a definite number of visits covered through lifetime.
txperweek Treatments per week Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a week.
txpermnth Treatments per month Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a month.
txlifetime Lifetime treatments Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a lifetime.
admitslifetime Lifetime admissions Measure of service covered by the plan benefit expressed in a definite number admission actions covered through lifetime.
procperwk Procedures per week Measure of service covered by the plan benefit expressed in a definite number procedure covered per week.
procpermnth Procedures per month Measure of service covered by the plan benefit expressed in a definite number procedure covered per month.
procperyr Procedures per year Measure of service covered by the plan benefit expressed in a definite number procedure covered per year.
proclifetime Lifetime procedures Measure of service covered by the plan benefit expressed in a definite number procedure covered per lifetime.
daysperadmission Days per admission Measure of service covered by the plan benefit expressed in a definite number of days covered for each individual admission.
procperepi Procedures per episode Measure 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 Bronze The '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 deductible A health insurance plan with higher premiums and lower out of pocket cost than a traditional health plan.
highded High deductible A health insurance plan with lower premiums and higher out of pocket cost than a traditional health plan.