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

: Insurance Product Type Code System - XML Representation

Active as of 2024-11-01

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="InsuranceProductTypeCS"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem InsuranceProductTypeCS</b></p><a name="InsuranceProductTypeCS"> </a><a name="hcInsuranceProductTypeCS"> </a><a name="InsuranceProductTypeCS-en-US"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/us/ndh/CodeSystem/InsuranceProductTypeCS</code> defines the following codes:</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap">commppo<a name="InsuranceProductTypeCS-commppo"> </a></td><td>Commercial PPO</td><td>Health insurance provided through a Preferred Provider Organization (PPO).</td></tr><tr><td style="white-space:nowrap">commhdhp<a name="InsuranceProductTypeCS-commhdhp"> </a></td><td>Commercial HDHP</td><td>Health insurance provided through a High Deductible Health Plan (HDHP).</td></tr><tr><td style="white-space:nowrap">commpos<a name="InsuranceProductTypeCS-commpos"> </a></td><td>Commercial POS</td><td>Health insurance provided through a Point-of-Service (POS) Plan.</td></tr><tr><td style="white-space:nowrap">commhmo<a name="InsuranceProductTypeCS-commhmo"> </a></td><td>Commercial HMO</td><td>Health insurance provided through a Health Maintenance Organization (HMO).</td></tr><tr><td style="white-space:nowrap">commepo<a name="InsuranceProductTypeCS-commepo"> </a></td><td>Commercial EPO</td><td>Health insurance provided through a Exclusive Provider Organization(EPO).</td></tr><tr><td style="white-space:nowrap">medi<a name="InsuranceProductTypeCS-medi"> </a></td><td>Medicaid</td><td>Health insurance provided to eligible adults and children under the Federal Medicaid program</td></tr><tr><td style="white-space:nowrap">medihmo<a name="InsuranceProductTypeCS-medihmo"> </a></td><td>Medicaid HMO</td><td>Health insurance provided to eligible adults and children under the Federal Medicaid program through a Health Maintenance Organization (HMO).</td></tr><tr><td style="white-space:nowrap">mediadv<a name="InsuranceProductTypeCS-mediadv"> </a></td><td>Medicare Advantage</td><td>Health insurance provided by a private company that contracts with Medicare to provide all Medicare Part A and Part B benefits.</td></tr><tr><td style="white-space:nowrap">mediadvhmo<a name="InsuranceProductTypeCS-mediadvhmo"> </a></td><td>Medicare Advantage HMO</td><td>Health insurance offered by a private company that contracts with Medicare to provide all Medicare Part A and Part B benefits through a Health Maintenance Organization (HMO).</td></tr><tr><td style="white-space:nowrap">media<a name="InsuranceProductTypeCS-media"> </a></td><td>Medicare Part A</td><td>Health insurance provided under the Federal Medicare program covering inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.</td></tr><tr><td style="white-space:nowrap">medib<a name="InsuranceProductTypeCS-medib"> </a></td><td>Medicare Part B</td><td>Health insurance provided under the Federal Medicfare program covering certain doctors' services, outpatient care, medical supplies, and preventive services.</td></tr><tr><td style="white-space:nowrap">medid<a name="InsuranceProductTypeCS-medid"> </a></td><td>Medicare Part D</td><td>Health insurance provided under the Federal Medicare program covering prescription drugs.</td></tr><tr><td style="white-space:nowrap">mediab<a name="InsuranceProductTypeCS-mediab"> </a></td><td>Medicare A/B</td><td>Health insurance provided under the Federal Medicare program covering inpatient hospital stays, care in a skilled nursing facility, hospice care, some home health care, certain doctors' services, outpatient care, medical supplies, and preventive services.</td></tr><tr><td style="white-space:nowrap">qhp<a name="InsuranceProductTypeCS-qhp"> </a></td><td>Qualified Health Plan</td><td>Health insurance provided through and certified by the Health Insurance Marketplace that provides essential health benefits (EHBs), follows established limits on cost sharing, and meets other requirements outlined within the application process.</td></tr><tr><td style="white-space:nowrap">ihs<a name="InsuranceProductTypeCS-ihs"> </a></td><td>Indian Health Service</td><td>Health care program provided to United States American Indians and Alaska Natives.</td></tr><tr><td style="white-space:nowrap">fep<a name="InsuranceProductTypeCS-fep"> </a></td><td>Federal Employee Program</td><td>Health insurance provided to employees of the Federal government.</td></tr><tr><td style="white-space:nowrap">tri<a name="InsuranceProductTypeCS-tri"> </a></td><td>TRICARE</td><td>Health care program provided to uniformed service members, retirees, and their families around the world.</td></tr><tr><td style="white-space:nowrap">va<a name="InsuranceProductTypeCS-va"> </a></td><td>Veterans Affairs Plan</td><td>Health care program provided to eligible veterans.</td></tr><tr><td style="white-space:nowrap">dent<a name="InsuranceProductTypeCS-dent"> </a></td><td>Dental Plan</td><td>Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the oral cavity.</td></tr><tr><td style="white-space:nowrap">denthmo<a name="InsuranceProductTypeCS-denthmo"> </a></td><td>Dental HMO</td><td>Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the oral cavity provided through a Health Maintenance Organization (HMO).</td></tr><tr><td style="white-space:nowrap">vis<a name="InsuranceProductTypeCS-vis"> </a></td><td>Vision Plan</td><td>Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the eyes.</td></tr><tr><td style="white-space:nowrap">vishmo<a name="InsuranceProductTypeCS-vishmo"> </a></td><td>Vision HMO</td><td>Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the eyes provided through a Health Maintenance Organization (HMO).</td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="pa"/>
  </extension>
  <url value="http://hl7.org/fhir/us/ndh/CodeSystem/InsuranceProductTypeCS"/>
  <version value="1.0.0-ballot"/>
  <name value="InsuranceProductTypeCS"/>
  <title value="Insurance Product Type Code System"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2024-11-01T19:22:54+00:00"/>
  <publisher value="HL7 International / Patient Administration"/>
  <contact>
    <name value="HL7 International / Patient Administration"/>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/pafm"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="pafm@lists.hl7.org"/>
    </telecom>
  </contact>
  <description
               value="A distinct package of health insurance coverage benefits that are offered using a particular product network type."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
      <display value="United States of America"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="22"/>
  <concept>
    <code value="commppo"/>
    <display value="Commercial PPO"/>
    <definition
                value="Health insurance provided through a Preferred Provider Organization (PPO)."/>
  </concept>
  <concept>
    <code value="commhdhp"/>
    <display value="Commercial HDHP"/>
    <definition
                value="Health insurance provided through a High Deductible Health Plan (HDHP)."/>
  </concept>
  <concept>
    <code value="commpos"/>
    <display value="Commercial POS"/>
    <definition
                value="Health insurance provided through a Point-of-Service (POS) Plan."/>
  </concept>
  <concept>
    <code value="commhmo"/>
    <display value="Commercial HMO"/>
    <definition
                value="Health insurance provided through a Health Maintenance Organization (HMO)."/>
  </concept>
  <concept>
    <code value="commepo"/>
    <display value="Commercial EPO"/>
    <definition
                value="Health insurance provided through a Exclusive Provider Organization(EPO)."/>
  </concept>
  <concept>
    <code value="medi"/>
    <display value="Medicaid"/>
    <definition
                value="Health insurance provided to eligible adults and children under the Federal Medicaid program"/>
  </concept>
  <concept>
    <code value="medihmo"/>
    <display value="Medicaid HMO"/>
    <definition
                value="Health insurance provided to eligible adults and children under the Federal Medicaid program through a Health Maintenance Organization (HMO)."/>
  </concept>
  <concept>
    <code value="mediadv"/>
    <display value="Medicare Advantage"/>
    <definition
                value="Health insurance provided by a private company that contracts with Medicare to provide all Medicare Part A and Part B benefits."/>
  </concept>
  <concept>
    <code value="mediadvhmo"/>
    <display value="Medicare Advantage HMO"/>
    <definition
                value="Health insurance offered by a private company that contracts with Medicare to provide all Medicare Part A and Part B benefits through a Health Maintenance Organization (HMO)."/>
  </concept>
  <concept>
    <code value="media"/>
    <display value="Medicare Part A"/>
    <definition
                value="Health insurance provided under the Federal Medicare program covering inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care."/>
  </concept>
  <concept>
    <code value="medib"/>
    <display value="Medicare Part B"/>
    <definition
                value="Health insurance provided under the Federal Medicfare program covering certain doctors' services, outpatient care, medical supplies, and preventive services."/>
  </concept>
  <concept>
    <code value="medid"/>
    <display value="Medicare Part D"/>
    <definition
                value="Health insurance provided under the Federal Medicare program covering prescription drugs."/>
  </concept>
  <concept>
    <code value="mediab"/>
    <display value="Medicare A/B"/>
    <definition
                value="Health insurance provided under the Federal Medicare program covering inpatient hospital stays, care in a skilled nursing facility, hospice care, some home health care, certain doctors' services, outpatient care, medical supplies, and preventive services."/>
  </concept>
  <concept>
    <code value="qhp"/>
    <display value="Qualified Health Plan"/>
    <definition
                value="Health insurance provided through and certified by the Health Insurance Marketplace that provides essential health benefits (EHBs), follows established limits on cost sharing, and meets other requirements outlined within the application process."/>
  </concept>
  <concept>
    <code value="ihs"/>
    <display value="Indian Health Service"/>
    <definition
                value="Health care program provided to United States American Indians and Alaska Natives."/>
  </concept>
  <concept>
    <code value="fep"/>
    <display value="Federal Employee Program"/>
    <definition
                value="Health insurance provided to employees of the Federal government."/>
  </concept>
  <concept>
    <code value="tri"/>
    <display value="TRICARE"/>
    <definition
                value="Health care program provided to uniformed service members, retirees, and their families around the world."/>
  </concept>
  <concept>
    <code value="va"/>
    <display value="Veterans Affairs Plan"/>
    <definition value="Health care program provided to eligible veterans."/>
  </concept>
  <concept>
    <code value="dent"/>
    <display value="Dental Plan"/>
    <definition
                value="Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the oral cavity."/>
  </concept>
  <concept>
    <code value="denthmo"/>
    <display value="Dental HMO"/>
    <definition
                value="Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the oral cavity provided through a Health Maintenance Organization (HMO)."/>
  </concept>
  <concept>
    <code value="vis"/>
    <display value="Vision Plan"/>
    <definition
                value="Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the eyes."/>
  </concept>
  <concept>
    <code value="vishmo"/>
    <display value="Vision HMO"/>
    <definition
                value="Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the eyes provided through a Health Maintenance Organization (HMO)."/>
  </concept>
</CodeSystem>