Validated Healthcare Directory
1.0.0 - STU1
Validated Healthcare Directory
1.0.0 - STU1
Validated Healthcare Directory, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/VhDir/ and changes regularly. See the Directory of published versions
| Active as of 2018-02-21 |
<CodeSystem xmlns="http://hl7.org/fhir">
<id value="payercharacteristics"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem payercharacteristics</b></p><a name="payercharacteristics"> </a><a name="hcpayercharacteristics"> </a><a name="payercharacteristics-en-US"> </a><p>This case-sensitive code system <code>http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics</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">medical<a name="payercharacteristics-medical"> </a></td><td>Medical</td><td>Medical insurance coverage.</td></tr><tr><td style="white-space:nowrap">dental<a name="payercharacteristics-dental"> </a></td><td>Dental</td><td>Dental insurance coverage.</td></tr><tr><td style="white-space:nowrap">menthlth<a name="payercharacteristics-menthlth"> </a></td><td>Mental Health</td><td>Mental health insurance coverage.</td></tr><tr><td style="white-space:nowrap">substanceabuse<a name="payercharacteristics-substanceabuse"> </a></td><td>Substance Abuse</td><td>Substance abuse services insurance coverage.</td></tr><tr><td style="white-space:nowrap">vision<a name="payercharacteristics-vision"> </a></td><td>Vision</td><td>Vision insurance coverage.</td></tr><tr><td style="white-space:nowrap">drug<a name="payercharacteristics-drug"> </a></td><td>Drug</td><td>Prescription drug coverage.</td></tr><tr><td style="white-space:nowrap">stc<a name="payercharacteristics-stc"> </a></td><td>Short Term Care</td><td>Short term care.</td></tr><tr><td style="white-space:nowrap">ltc<a name="payercharacteristics-ltc"> </a></td><td>Long Term Care</td><td>Long term care.</td></tr><tr><td style="white-space:nowrap">hospice<a name="payercharacteristics-hospice"> </a></td><td>Hospice</td><td>Hospice insurance coverage.</td></tr><tr><td style="white-space:nowrap">homehealth<a name="payercharacteristics-homehealth"> </a></td><td>Home Health</td><td>Home health services insurance coverage.</td></tr><tr><td style="white-space:nowrap">dmepos<a name="payercharacteristics-dmepos"> </a></td><td>DMEPOS</td><td>Durable Medical Equipment, Prosthetics/Orthotics and Supplies.</td></tr><tr><td style="white-space:nowrap">imagingadv<a name="payercharacteristics-imagingadv"> </a></td><td>Advanced Imaging (CT/PET Scans, MRIs)</td><td>Advances imaging techniques services (CT/PET Scans, MRIs) coverage.</td></tr><tr><td style="white-space:nowrap">rehab<a name="payercharacteristics-rehab"> </a></td><td>Rehabilitation</td><td>Rehabilitation.</td></tr><tr><td style="white-space:nowrap">pcpov<a name="payercharacteristics-pcpov"> </a></td><td>Primary Care Visit to Treat an Injury or Illness</td><td>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.</td></tr><tr><td style="white-space:nowrap">specialistov<a name="payercharacteristics-specialistov"> </a></td><td>Specialist Office Visit</td><td>Covered healthcare service rendered to a patient by a specialty provider.</td></tr><tr><td style="white-space:nowrap">mlpov<a name="payercharacteristics-mlpov"> </a></td><td>Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional</td><td>Benefit plan covers covered health related services rendered by a practioner other than MD or DO and referred to as other practitioner.</td></tr><tr><td style="white-space:nowrap">outpatient<a name="payercharacteristics-outpatient"> </a></td><td>Outpatient Facility Fee (e.g., Ambulatory Surgery Center)</td><td>Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission.</td></tr><tr><td style="white-space:nowrap">outpatstx<a name="payercharacteristics-outpatstx"> </a></td><td>Outpatient Surgery Physician/Surgical Services</td><td>Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient.</td></tr><tr><td style="white-space:nowrap">hospserv<a name="payercharacteristics-hospserv"> </a></td><td>Hospice Services</td><td>Benefit plan covers hospice services.</td></tr><tr><td style="white-space:nowrap">routinedental<a name="payercharacteristics-routinedental"> </a></td><td>Routine Dental Services (Adult)</td><td>Benefit plan covers routine dental services.</td></tr><tr><td style="white-space:nowrap">infertilitytx<a name="payercharacteristics-infertilitytx"> </a></td><td>Infertility Treatment</td><td>Benefit plan covers eligible infertility treatment services.</td></tr><tr><td style="white-space:nowrap">ltnhc<a name="payercharacteristics-ltnhc"> </a></td><td>Long-Term/Custodial Nursing Home Care</td><td>Long-Term/Custodial Nursing Home Care.</td></tr><tr><td style="white-space:nowrap">privatenurse<a name="payercharacteristics-privatenurse"> </a></td><td>Private-Duty Nursing</td><td>Private-Duty Nursing.</td></tr><tr><td style="white-space:nowrap">routineeye<a name="payercharacteristics-routineeye"> </a></td><td>Routine Eye Exam (Adult)</td><td>Routine Eye Exam (Adult).</td></tr><tr><td style="white-space:nowrap">ucservice<a name="payercharacteristics-ucservice"> </a></td><td>Urgent Care Centers or Facilities</td><td>Urgent Care Centers or Facilities.</td></tr><tr><td style="white-space:nowrap">erservice<a name="payercharacteristics-erservice"> </a></td><td>Emergency Room Services</td><td>Emergency Room Services.</td></tr><tr><td style="white-space:nowrap">ambulance<a name="payercharacteristics-ambulance"> </a></td><td>Emergency Room Services</td><td>Emergency Room Services.</td></tr><tr><td style="white-space:nowrap">inpatienthospital<a name="payercharacteristics-inpatienthospital"> </a></td><td>Inpatient Hospital Services (e.g., Hospital Stay)</td><td>A person who is hospitalized for at least one night to receive treatment or participate in a study.</td></tr><tr><td style="white-space:nowrap">inpatientprovider<a name="payercharacteristics-inpatientprovider"> </a></td><td>Inpatient Physician and Surgical Services</td><td>A healthcare provider who is delivering healthcare services in a hospital environment.</td></tr><tr><td style="white-space:nowrap">bariatricsurg<a name="payercharacteristics-bariatricsurg"> </a></td><td>Bariatric Surgery</td><td>Bariatric surgery service Skilled nursing service (qualifier value).</td></tr><tr><td style="white-space:nowrap">cosmeticsurg<a name="payercharacteristics-cosmeticsurg"> </a></td><td>Cosmetic Surgery</td><td>Cosmetic surgery service Skilled nursing service (qualifier value).</td></tr><tr><td style="white-space:nowrap">skillednursing<a name="payercharacteristics-skillednursing"> </a></td><td>Skilled Nursing Facility</td><td>Skilled nursing service (qualifier value).</td></tr><tr><td style="white-space:nowrap">ppnatalcare<a name="payercharacteristics-ppnatalcare"> </a></td><td>Prenatal and Postnatal Care</td><td>Prenatal and Postnatal services.</td></tr><tr><td style="white-space:nowrap">maternitycare<a name="payercharacteristics-maternitycare"> </a></td><td>Delivery and All Inpatient Services for Maternity Care</td><td>All maternity care services.</td></tr><tr><td style="white-space:nowrap">menthlthoutp<a name="payercharacteristics-menthlthoutp"> </a></td><td>Mental/Behavioral Health Outpatient Services</td><td>Mental health service delivered in an outpatient setting.</td></tr><tr><td style="white-space:nowrap">menthlthinp<a name="payercharacteristics-menthlthinp"> </a></td><td>Mental/Behavioral Health Inpatient Services</td><td>Mental health service delivered in an hospital or inpatient facility setting.</td></tr><tr><td style="white-space:nowrap">sadoutp<a name="payercharacteristics-sadoutp"> </a></td><td>Substance Abuse Disorder Outpatient Services</td><td>Substance abuse related services delivered in a outpatient setting.</td></tr><tr><td style="white-space:nowrap">sadinp<a name="payercharacteristics-sadinp"> </a></td><td>Substance Abuse Disorder Inpatient Services</td><td>Substance abuse related services delivered in a inpatient setting.</td></tr><tr><td style="white-space:nowrap">drggenric<a name="payercharacteristics-drggenric"> </a></td><td>Generic Drugs</td><td>Generic drugs eligible benefits.</td></tr><tr><td style="white-space:nowrap">drgbrand<a name="payercharacteristics-drgbrand"> </a></td><td>Preferred Brand Drugs</td><td>Preferred brand drugs eligible benefits.</td></tr><tr><td style="white-space:nowrap">drgnonpreferred<a name="payercharacteristics-drgnonpreferred"> </a></td><td>Non-Preferred Brand Drugs</td><td>Non-Preferred drugs brands eligible benefits.</td></tr><tr><td style="white-space:nowrap">drgspecialty<a name="payercharacteristics-drgspecialty"> </a></td><td>Specialty Drugs</td><td>Benefit plan covers specialty drugs.</td></tr><tr><td style="white-space:nowrap">rehaboutp<a name="payercharacteristics-rehaboutp"> </a></td><td>Outpatient Rehabilitation Services</td><td>Benefit plan covers outpatient rehabilitation services.</td></tr><tr><td style="white-space:nowrap">servicehablitation<a name="payercharacteristics-servicehablitation"> </a></td><td>Habilitation Services</td><td>Habilitation Services.</td></tr><tr><td style="white-space:nowrap">chiro<a name="payercharacteristics-chiro"> </a></td><td>Chiropractic Care</td><td>Benefit plan covers chiropractor eligible benefits.</td></tr><tr><td style="white-space:nowrap">dme<a name="payercharacteristics-dme"> </a></td><td>Durable Medical Equipment</td><td>Benefit plan covers Durable medical equipment eligible benefits.</td></tr><tr><td style="white-space:nowrap">hearingaids<a name="payercharacteristics-hearingaids"> </a></td><td>Hearing Aids</td><td>Benefit plan covers hearing aids.</td></tr><tr><td style="white-space:nowrap">imgctpetmri<a name="payercharacteristics-imgctpetmri"> </a></td><td>Imaging (CT/PET Scans, MRIs)</td><td>Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services.</td></tr><tr><td style="white-space:nowrap">prev<a name="payercharacteristics-prev"> </a></td><td>Preventive Care/Screening/Immunization</td><td>Routine healthcare services to prevent health related problems eligible benefits.</td></tr><tr><td style="white-space:nowrap">rtnpod<a name="payercharacteristics-rtnpod"> </a></td><td>Routine Foot Care</td><td>Routine Foot Care.</td></tr><tr><td style="white-space:nowrap">acupuncture<a name="payercharacteristics-acupuncture"> </a></td><td>Acupuncture</td><td>Benefit plan covers acupuncture treatment.</td></tr><tr><td style="white-space:nowrap">weightloss<a name="payercharacteristics-weightloss"> </a></td><td>Weight Loss Programs</td><td>Benefit plan covers weight loss services eligible benefits.</td></tr><tr><td style="white-space:nowrap">rtneyechld<a name="payercharacteristics-rtneyechld"> </a></td><td>Routine Eye Exam for Children</td><td>Routine eye exam for children eligible benefits.</td></tr><tr><td style="white-space:nowrap">glasseschld<a name="payercharacteristics-glasseschld"> </a></td><td>Eye Glasses for Children</td><td>Eye glasses children eligible benefits.</td></tr><tr><td style="white-space:nowrap">rtndntlchld<a name="payercharacteristics-rtndntlchld"> </a></td><td>Dental Check-Up for Children</td><td>Dental Check-Up for Children.</td></tr><tr><td style="white-space:nowrap">speachthpy<a name="payercharacteristics-speachthpy"> </a></td><td>Rehabilitative Speech Therapy</td><td>Benefit plan covers rehabilitative speech therapy eligible benefits.</td></tr><tr><td style="white-space:nowrap">rehaboccandpt<a name="payercharacteristics-rehaboccandpt"> </a></td><td>Rehabilitative Occupational and Rehabilitative Physical Therapy</td><td>Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.</td></tr><tr><td style="white-space:nowrap">wellbaby<a name="payercharacteristics-wellbaby"> </a></td><td>Well Baby Visits and Care</td><td>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.</td></tr><tr><td style="white-space:nowrap">laboutp<a name="payercharacteristics-laboutp"> </a></td><td>Laboratory Outpatient and Professional Services</td><td>Benefit plan covers laboratory testing and related professional services received as outpatient.</td></tr><tr><td style="white-space:nowrap">imagingdx<a name="payercharacteristics-imagingdx"> </a></td><td>X-rays and Diagnostic Imaging</td><td>Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases.</td></tr><tr><td style="white-space:nowrap">dntlbaschld<a name="payercharacteristics-dntlbaschld"> </a></td><td>Basic Dental Care – Child</td><td>Benefit plan covers diagnostic basic dental care.</td></tr><tr><td style="white-space:nowrap">orthochld<a name="payercharacteristics-orthochld"> </a></td><td>Orthodontia – Child</td><td>Benefit plan covers orthodontia for children.</td></tr><tr><td style="white-space:nowrap">dntlmajchld<a name="payercharacteristics-dntlmajchld"> </a></td><td>Major Dental Care – Child</td><td>Benefit plan covers major dental care for children.</td></tr><tr><td style="white-space:nowrap">dntlbasadlt<a name="payercharacteristics-dntlbasadlt"> </a></td><td>Basic Dental Care – Adult</td><td>Benefit plan covers basic dental care for adults.</td></tr><tr><td style="white-space:nowrap">orthodadlt<a name="payercharacteristics-orthodadlt"> </a></td><td>Orthodontia – Adult</td><td>Benefits plan covers services provided that are required for orthodontic purposes for an adult.</td></tr><tr><td style="white-space:nowrap">dntlmajadlt<a name="payercharacteristics-dntlmajadlt"> </a></td><td>Major Dental Care – Adult</td><td>Benefit plan covers major dental care for adult.</td></tr><tr><td style="white-space:nowrap">abortion<a name="payercharacteristics-abortion"> </a></td><td>Abortion for Which Public Funding is Prohibited</td><td>Benefit plan covers services for abortion for which public funding is prohibited.</td></tr><tr><td style="white-space:nowrap">transplant<a name="payercharacteristics-transplant"> </a></td><td>Transplant</td><td>Benefit plan covers transplant related services.</td></tr><tr><td style="white-space:nowrap">accdntl<a name="payercharacteristics-accdntl"> </a></td><td>Accidental Dental</td><td>Benefit plan covers dental care services related to an accident.</td></tr><tr><td style="white-space:nowrap">dialysis<a name="payercharacteristics-dialysis"> </a></td><td>Dialysis</td><td>The plan benefit covers services used to treat end stage renal disease.</td></tr><tr><td style="white-space:nowrap">testallrgy<a name="payercharacteristics-testallrgy"> </a></td><td>Allergy Testing</td><td>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.</td></tr><tr><td style="white-space:nowrap">chemotherapy<a name="payercharacteristics-chemotherapy"> </a></td><td>Chemotherapy</td><td>The plan benefits cover services the use of drugs and approved chemicals to treat disease.</td></tr><tr><td style="white-space:nowrap">radiation<a name="payercharacteristics-radiation"> </a></td><td>Radiation</td><td>The plan benefits cover services the use radiation to treat disease.</td></tr><tr><td style="white-space:nowrap">edudiab<a name="payercharacteristics-edudiab"> </a></td><td>Diabetes Education</td><td>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.</td></tr><tr><td style="white-space:nowrap">prosthetic<a name="payercharacteristics-prosthetic"> </a></td><td>Prosthetic Devices</td><td>Plan benefit covers services related to prosthesis devices.</td></tr><tr><td style="white-space:nowrap">infusiontx<a name="payercharacteristics-infusiontx"> </a></td><td>Infusion Therapy</td><td>Plan benefit covers services related to infusion therapy.</td></tr><tr><td style="white-space:nowrap">tmjtx<a name="payercharacteristics-tmjtx"> </a></td><td>Treatment for Temporomandibular Joint Disorders</td><td>Plan benefit covers services related to treatment of Temporomandibular Joint disorder.</td></tr><tr><td style="white-space:nowrap">nutrition<a name="payercharacteristics-nutrition"> </a></td><td>Nutritional Counseling</td><td>Nutritional Counseling.</td></tr><tr><td style="white-space:nowrap">reconsurg<a name="payercharacteristics-reconsurg"> </a></td><td>Reconstructive Surgery</td><td>Plan benefit covers services related to reconstructive surgery.</td></tr><tr><td style="white-space:nowrap">days<a name="payercharacteristics-days"> </a></td><td>Days</td><td>Measure of service covered by the plan benefit expressed in a definite number of days.</td></tr><tr><td style="white-space:nowrap">visit<a name="payercharacteristics-visit"> </a></td><td>Visits</td><td>Measure of service covered by the plan benefit expressed in a definite number of visits.</td></tr><tr><td style="white-space:nowrap">procedure<a name="payercharacteristics-procedure"> </a></td><td>Procedures</td><td>Measure of service covered by the plan benefit expressed in a set of actions covered.</td></tr><tr><td style="white-space:nowrap">admission<a name="payercharacteristics-admission"> </a></td><td>Admissions</td><td>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.</td></tr><tr><td style="white-space:nowrap">visithrs<a name="payercharacteristics-visithrs"> </a></td><td>Hours per visit</td><td>Measure expresses how many hours per visit are covered by the insurance benefit plan.</td></tr><tr><td style="white-space:nowrap">weekhrs<a name="payercharacteristics-weekhrs"> </a></td><td>Hours per week</td><td>Measure expresses how many hours per week are covered by the insurance benefit plan.</td></tr><tr><td style="white-space:nowrap">mthhrs<a name="payercharacteristics-mthhrs"> </a></td><td>Hours per month</td><td>Measure expressed how many hours per month are covered by the insurance benefit plan.</td></tr><tr><td style="white-space:nowrap">yrhrs<a name="payercharacteristics-yrhrs"> </a></td><td>Hours per year</td><td>Measure expreses how many hours per year are covered by the insurance benfit plan.</td></tr><tr><td style="white-space:nowrap">daysperwk<a name="payercharacteristics-daysperwk"> </a></td><td>Days per week</td><td>Measure of service covered by the plan benefit expressed in a how many days are covered in a week.</td></tr><tr><td style="white-space:nowrap">dayspermth<a name="payercharacteristics-dayspermth"> </a></td><td>Days per month</td><td>Measure of service covered by the plan benefit expressed in a how many days are covered in a month.</td></tr><tr><td style="white-space:nowrap">daysperyr<a name="payercharacteristics-daysperyr"> </a></td><td>Days per year</td><td>Measure of service covered by the plan benefit expressed in a how many days are covered in a year.</td></tr><tr><td style="white-space:nowrap">mthsperyr<a name="payercharacteristics-mthsperyr"> </a></td><td>Months per year</td><td>Measure of service covered by the plan benefit expressed in a how many month are covered in a year.</td></tr><tr><td style="white-space:nowrap">visitsperday<a name="payercharacteristics-visitsperday"> </a></td><td>Visits per day</td><td>Measure of service covered by the plan benefit expressed in a definite number of visits covered per day.</td></tr><tr><td style="white-space:nowrap">visitsperweek<a name="payercharacteristics-visitsperweek"> </a></td><td>Visits per week</td><td>Measure of service covered by the plan benefit expressed in a definite number of visits covered per week.</td></tr><tr><td style="white-space:nowrap">visitspermth<a name="payercharacteristics-visitspermth"> </a></td><td>Visits per month</td><td>Measure of service covered by the plan benefit expressed in a definite number of visits covered per month.</td></tr><tr><td style="white-space:nowrap">visitsperyr<a name="payercharacteristics-visitsperyr"> </a></td><td>Visits per year</td><td>Measure of service covered by the plan benefit expressed in a definite number of visits covered per year.</td></tr><tr><td style="white-space:nowrap">lifetimevisits<a name="payercharacteristics-lifetimevisits"> </a></td><td>Lifetime visits</td><td>Measure of service covered by the plan benefit expressed in a definite number of visits covered through lifetime.</td></tr><tr><td style="white-space:nowrap">txperweek<a name="payercharacteristics-txperweek"> </a></td><td>Treatments per week</td><td>Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a week.</td></tr><tr><td style="white-space:nowrap">txpermnth<a name="payercharacteristics-txpermnth"> </a></td><td>Treatments per month</td><td>Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a month.</td></tr><tr><td style="white-space:nowrap">txlifetime<a name="payercharacteristics-txlifetime"> </a></td><td>Lifetime treatments</td><td>Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a lifetime.</td></tr><tr><td style="white-space:nowrap">admitslifetime<a name="payercharacteristics-admitslifetime"> </a></td><td>Lifetime admissions</td><td>Measure of service covered by the plan benefit expressed in a definite number admission actions covered through lifetime.</td></tr><tr><td style="white-space:nowrap">procperwk<a name="payercharacteristics-procperwk"> </a></td><td>Procedures per week</td><td>Measure of service covered by the plan benefit expressed in a definite number procedure covered per week.</td></tr><tr><td style="white-space:nowrap">procpermnth<a name="payercharacteristics-procpermnth"> </a></td><td>Procedures per month</td><td>Measure of service covered by the plan benefit expressed in a definite number procedure covered per month.</td></tr><tr><td style="white-space:nowrap">procperyr<a name="payercharacteristics-procperyr"> </a></td><td>Procedures per year</td><td>Measure of service covered by the plan benefit expressed in a definite number procedure covered per year.</td></tr><tr><td style="white-space:nowrap">proclifetime<a name="payercharacteristics-proclifetime"> </a></td><td>Lifetime procedures</td><td>Measure of service covered by the plan benefit expressed in a definite number procedure covered per lifetime.</td></tr><tr><td style="white-space:nowrap">daysperadmission<a name="payercharacteristics-daysperadmission"> </a></td><td>Days per admission</td><td>Measure of service covered by the plan benefit expressed in a definite number of days covered for each individual admission.</td></tr><tr><td style="white-space:nowrap">procperepi<a name="payercharacteristics-procperepi"> </a></td><td>Procedures per episode</td><td>Measure of service covered by the plan benefit expressed in a definite number of procedures covered for each individual treatment episode.</td></tr><tr><td style="white-space:nowrap">cat<a name="payercharacteristics-cat"> </a></td><td>Catastrophic</td><td>'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.</td></tr><tr><td style="white-space:nowrap">bronze<a name="payercharacteristics-bronze"> </a></td><td>Bronze</td><td>'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.</td></tr><tr><td style="white-space:nowrap">bronzeexp<a name="payercharacteristics-bronzeexp"> </a></td><td>Expanded Bronze</td><td>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.</td></tr><tr><td style="white-space:nowrap">silver<a name="payercharacteristics-silver"> </a></td><td>Silver</td><td>'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.</td></tr><tr><td style="white-space:nowrap">gold<a name="payercharacteristics-gold"> </a></td><td>Gold</td><td>'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.</td></tr><tr><td style="white-space:nowrap">platinum<a name="payercharacteristics-platinum"> </a></td><td>Platinum</td><td>'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.</td></tr><tr><td style="white-space:nowrap">lowded<a name="payercharacteristics-lowded"> </a></td><td>Low deductible</td><td>A health insurance plan with higher premiums and lower out of pocket cost than a traditional health plan.</td></tr><tr><td style="white-space:nowrap">highded<a name="payercharacteristics-highded"> </a></td><td>High deductible</td><td>A health insurance plan with lower premiums and higher out of pocket cost than a traditional health plan.</td></tr></table></div>
</text>
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url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
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<url value="http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics"/>
<version value="1.0.0"/>
<name value="VhDirPayerCharacteristics"/>
<title value="VhDir Payer Characteristics Code System"/>
<status value="active"/>
<experimental value="false"/>
<date value="2018-02-21"/>
<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="This code system contains codes for documenting attributes of a Payor related resources."/>
<jurisdiction>
<coding>
<system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
<code value="001"/>
<display value="World"/>
</coding>
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<copyright
value="Used by permission of HL7 International all rights reserved Creative Commons License"/>
<caseSensitive value="true"/>
<content value="complete"/>
<concept>
<code value="medical"/>
<display value="Medical"/>
<definition value="Medical insurance coverage."/>
</concept>
<concept>
<code value="dental"/>
<display value="Dental"/>
<definition value="Dental insurance coverage."/>
</concept>
<concept>
<code value="menthlth"/>
<display value="Mental Health"/>
<definition value="Mental health insurance coverage."/>
</concept>
<concept>
<code value="substanceabuse"/>
<display value="Substance Abuse"/>
<definition value="Substance abuse services insurance coverage."/>
</concept>
<concept>
<code value="vision"/>
<display value="Vision"/>
<definition value="Vision insurance coverage."/>
</concept>
<concept>
<code value="drug"/>
<display value="Drug"/>
<definition value="Prescription drug coverage."/>
</concept>
<concept>
<code value="stc"/>
<display value="Short Term Care"/>
<definition value="Short term care."/>
</concept>
<concept>
<code value="ltc"/>
<display value="Long Term Care"/>
<definition value="Long term care."/>
</concept>
<concept>
<code value="hospice"/>
<display value="Hospice"/>
<definition value="Hospice insurance coverage."/>
</concept>
<concept>
<code value="homehealth"/>
<display value="Home Health"/>
<definition value="Home health services insurance coverage."/>
</concept>
<concept>
<code value="dmepos"/>
<display value="DMEPOS"/>
<definition
value="Durable Medical Equipment, Prosthetics/Orthotics and Supplies."/>
</concept>
<concept>
<code value="imagingadv"/>
<display value="Advanced Imaging (CT/PET Scans, MRIs)"/>
<definition
value="Advances imaging techniques services (CT/PET Scans, MRIs) coverage."/>
</concept>
<concept>
<code value="rehab"/>
<display value="Rehabilitation"/>
<definition value="Rehabilitation."/>
</concept>
<concept>
<code value="pcpov"/>
<display value="Primary Care Visit to Treat an Injury or Illness"/>
<definition
value="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."/>
</concept>
<concept>
<code value="specialistov"/>
<display value="Specialist Office Visit"/>
<definition
value="Covered healthcare service rendered to a patient by a specialty provider."/>
</concept>
<concept>
<code value="mlpov"/>
<display
value="Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional"/>
<definition
value="Benefit plan covers covered health related services rendered by a practioner other than MD or DO and referred to as other practitioner."/>
</concept>
<concept>
<code value="outpatient"/>
<display
value="Outpatient Facility Fee (e.g., Ambulatory Surgery Center)"/>
<definition
value="Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission."/>
</concept>
<concept>
<code value="outpatstx"/>
<display value="Outpatient Surgery Physician/Surgical Services"/>
<definition
value="Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient."/>
</concept>
<concept>
<code value="hospserv"/>
<display value="Hospice Services"/>
<definition value="Benefit plan covers hospice services."/>
</concept>
<concept>
<code value="routinedental"/>
<display value="Routine Dental Services (Adult)"/>
<definition value="Benefit plan covers routine dental services."/>
</concept>
<concept>
<code value="infertilitytx"/>
<display value="Infertility Treatment"/>
<definition
value="Benefit plan covers eligible infertility treatment services."/>
</concept>
<concept>
<code value="ltnhc"/>
<display value="Long-Term/Custodial Nursing Home Care"/>
<definition value="Long-Term/Custodial Nursing Home Care."/>
</concept>
<concept>
<code value="privatenurse"/>
<display value="Private-Duty Nursing"/>
<definition value="Private-Duty Nursing."/>
</concept>
<concept>
<code value="routineeye"/>
<display value="Routine Eye Exam (Adult)"/>
<definition value="Routine Eye Exam (Adult)."/>
</concept>
<concept>
<code value="ucservice"/>
<display value="Urgent Care Centers or Facilities"/>
<definition value="Urgent Care Centers or Facilities."/>
</concept>
<concept>
<code value="erservice"/>
<display value="Emergency Room Services"/>
<definition value="Emergency Room Services."/>
</concept>
<concept>
<code value="ambulance"/>
<display value="Emergency Room Services"/>
<definition value="Emergency Room Services."/>
</concept>
<concept>
<code value="inpatienthospital"/>
<display value="Inpatient Hospital Services (e.g., Hospital Stay)"/>
<definition
value="A person who is hospitalized for at least one night to receive treatment or participate in a study."/>
</concept>
<concept>
<code value="inpatientprovider"/>
<display value="Inpatient Physician and Surgical Services"/>
<definition
value="A healthcare provider who is delivering healthcare services in a hospital environment."/>
</concept>
<concept>
<code value="bariatricsurg"/>
<display value="Bariatric Surgery"/>
<definition
value="Bariatric surgery service Skilled nursing service (qualifier value)."/>
</concept>
<concept>
<code value="cosmeticsurg"/>
<display value="Cosmetic Surgery"/>
<definition
value="Cosmetic surgery service Skilled nursing service (qualifier value)."/>
</concept>
<concept>
<code value="skillednursing"/>
<display value="Skilled Nursing Facility"/>
<definition value="Skilled nursing service (qualifier value)."/>
</concept>
<concept>
<code value="ppnatalcare"/>
<display value="Prenatal and Postnatal Care"/>
<definition value="Prenatal and Postnatal services."/>
</concept>
<concept>
<code value="maternitycare"/>
<display value="Delivery and All Inpatient Services for Maternity Care"/>
<definition value="All maternity care services."/>
</concept>
<concept>
<code value="menthlthoutp"/>
<display value="Mental/Behavioral Health Outpatient Services"/>
<definition
value="Mental health service delivered in an outpatient setting."/>
</concept>
<concept>
<code value="menthlthinp"/>
<display value="Mental/Behavioral Health Inpatient Services"/>
<definition
value="Mental health service delivered in an hospital or inpatient facility setting."/>
</concept>
<concept>
<code value="sadoutp"/>
<display value="Substance Abuse Disorder Outpatient Services"/>
<definition
value="Substance abuse related services delivered in a outpatient setting."/>
</concept>
<concept>
<code value="sadinp"/>
<display value="Substance Abuse Disorder Inpatient Services"/>
<definition
value="Substance abuse related services delivered in a inpatient setting."/>
</concept>
<concept>
<code value="drggenric"/>
<display value="Generic Drugs"/>
<definition value="Generic drugs eligible benefits."/>
</concept>
<concept>
<code value="drgbrand"/>
<display value="Preferred Brand Drugs"/>
<definition value="Preferred brand drugs eligible benefits."/>
</concept>
<concept>
<code value="drgnonpreferred"/>
<display value="Non-Preferred Brand Drugs"/>
<definition value="Non-Preferred drugs brands eligible benefits."/>
</concept>
<concept>
<code value="drgspecialty"/>
<display value="Specialty Drugs"/>
<definition value="Benefit plan covers specialty drugs."/>
</concept>
<concept>
<code value="rehaboutp"/>
<display value="Outpatient Rehabilitation Services"/>
<definition
value="Benefit plan covers outpatient rehabilitation services."/>
</concept>
<concept>
<code value="servicehablitation"/>
<display value="Habilitation Services"/>
<definition value="Habilitation Services."/>
</concept>
<concept>
<code value="chiro"/>
<display value="Chiropractic Care"/>
<definition value="Benefit plan covers chiropractor eligible benefits."/>
</concept>
<concept>
<code value="dme"/>
<display value="Durable Medical Equipment"/>
<definition
value="Benefit plan covers Durable medical equipment eligible benefits."/>
</concept>
<concept>
<code value="hearingaids"/>
<display value="Hearing Aids"/>
<definition value="Benefit plan covers hearing aids."/>
</concept>
<concept>
<code value="imgctpetmri"/>
<display value="Imaging (CT/PET Scans, MRIs)"/>
<definition
value="Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services."/>
</concept>
<concept>
<code value="prev"/>
<display value="Preventive Care/Screening/Immunization"/>
<definition
value="Routine healthcare services to prevent health related problems eligible benefits."/>
</concept>
<concept>
<code value="rtnpod"/>
<display value="Routine Foot Care"/>
<definition value="Routine Foot Care."/>
</concept>
<concept>
<code value="acupuncture"/>
<display value="Acupuncture"/>
<definition value="Benefit plan covers acupuncture treatment."/>
</concept>
<concept>
<code value="weightloss"/>
<display value="Weight Loss Programs"/>
<definition
value="Benefit plan covers weight loss services eligible benefits."/>
</concept>
<concept>
<code value="rtneyechld"/>
<display value="Routine Eye Exam for Children"/>
<definition value="Routine eye exam for children eligible benefits."/>
</concept>
<concept>
<code value="glasseschld"/>
<display value="Eye Glasses for Children"/>
<definition value="Eye glasses children eligible benefits."/>
</concept>
<concept>
<code value="rtndntlchld"/>
<display value="Dental Check-Up for Children"/>
<definition value="Dental Check-Up for Children."/>
</concept>
<concept>
<code value="speachthpy"/>
<display value="Rehabilitative Speech Therapy"/>
<definition
value="Benefit plan covers rehabilitative speech therapy eligible benefits."/>
</concept>
<concept>
<code value="rehaboccandpt"/>
<display
value="Rehabilitative Occupational and Rehabilitative Physical Therapy"/>
<definition
value="Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits."/>
</concept>
<concept>
<code value="wellbaby"/>
<display value="Well Baby Visits and Care"/>
<definition
value="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."/>
</concept>
<concept>
<code value="laboutp"/>
<display value="Laboratory Outpatient and Professional Services"/>
<definition
value="Benefit plan covers laboratory testing and related professional services received as outpatient."/>
</concept>
<concept>
<code value="imagingdx"/>
<display value="X-rays and Diagnostic Imaging"/>
<definition
value="Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases."/>
</concept>
<concept>
<code value="dntlbaschld"/>
<display value="Basic Dental Care – Child"/>
<definition value="Benefit plan covers diagnostic basic dental care."/>
</concept>
<concept>
<code value="orthochld"/>
<display value="Orthodontia – Child"/>
<definition value="Benefit plan covers orthodontia for children."/>
</concept>
<concept>
<code value="dntlmajchld"/>
<display value="Major Dental Care – Child"/>
<definition value="Benefit plan covers major dental care for children."/>
</concept>
<concept>
<code value="dntlbasadlt"/>
<display value="Basic Dental Care – Adult"/>
<definition value="Benefit plan covers basic dental care for adults."/>
</concept>
<concept>
<code value="orthodadlt"/>
<display value="Orthodontia – Adult"/>
<definition
value="Benefits plan covers services provided that are required for orthodontic purposes for an adult."/>
</concept>
<concept>
<code value="dntlmajadlt"/>
<display value="Major Dental Care – Adult"/>
<definition value="Benefit plan covers major dental care for adult."/>
</concept>
<concept>
<code value="abortion"/>
<display value="Abortion for Which Public Funding is Prohibited"/>
<definition
value="Benefit plan covers services for abortion for which public funding is prohibited."/>
</concept>
<concept>
<code value="transplant"/>
<display value="Transplant"/>
<definition value="Benefit plan covers transplant related services."/>
</concept>
<concept>
<code value="accdntl"/>
<display value="Accidental Dental"/>
<definition
value="Benefit plan covers dental care services related to an accident."/>
</concept>
<concept>
<code value="dialysis"/>
<display value="Dialysis"/>
<definition
value="The plan benefit covers services used to treat end stage renal disease."/>
</concept>
<concept>
<code value="testallrgy"/>
<display value="Allergy Testing"/>
<definition
value="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."/>
</concept>
<concept>
<code value="chemotherapy"/>
<display value="Chemotherapy"/>
<definition
value="The plan benefits cover services the use of drugs and approved chemicals to treat disease."/>
</concept>
<concept>
<code value="radiation"/>
<display value="Radiation"/>
<definition
value="The plan benefits cover services the use radiation to treat disease."/>
</concept>
<concept>
<code value="edudiab"/>
<display value="Diabetes Education"/>
<definition
value="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."/>
</concept>
<concept>
<code value="prosthetic"/>
<display value="Prosthetic Devices"/>
<definition
value="Plan benefit covers services related to prosthesis devices."/>
</concept>
<concept>
<code value="infusiontx"/>
<display value="Infusion Therapy"/>
<definition
value="Plan benefit covers services related to infusion therapy."/>
</concept>
<concept>
<code value="tmjtx"/>
<display value="Treatment for Temporomandibular Joint Disorders"/>
<definition
value="Plan benefit covers services related to treatment of Temporomandibular Joint disorder."/>
</concept>
<concept>
<code value="nutrition"/>
<display value="Nutritional Counseling"/>
<definition value="Nutritional Counseling."/>
</concept>
<concept>
<code value="reconsurg"/>
<display value="Reconstructive Surgery"/>
<definition
value="Plan benefit covers services related to reconstructive surgery."/>
</concept>
<concept>
<code value="days"/>
<display value="Days"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of days."/>
</concept>
<concept>
<code value="visit"/>
<display value="Visits"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of visits."/>
</concept>
<concept>
<code value="procedure"/>
<display value="Procedures"/>
<definition
value="Measure of service covered by the plan benefit expressed in a set of actions covered."/>
</concept>
<concept>
<code value="admission"/>
<display value="Admissions"/>
<definition
value="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."/>
</concept>
<concept>
<code value="visithrs"/>
<display value="Hours per visit"/>
<definition
value="Measure expresses how many hours per visit are covered by the insurance benefit plan."/>
</concept>
<concept>
<code value="weekhrs"/>
<display value="Hours per week"/>
<definition
value="Measure expresses how many hours per week are covered by the insurance benefit plan."/>
</concept>
<concept>
<code value="mthhrs"/>
<display value="Hours per month"/>
<definition
value="Measure expressed how many hours per month are covered by the insurance benefit plan."/>
</concept>
<concept>
<code value="yrhrs"/>
<display value="Hours per year"/>
<definition
value="Measure expreses how many hours per year are covered by the insurance benfit plan."/>
</concept>
<concept>
<code value="daysperwk"/>
<display value="Days per week"/>
<definition
value="Measure of service covered by the plan benefit expressed in a how many days are covered in a week."/>
</concept>
<concept>
<code value="dayspermth"/>
<display value="Days per month"/>
<definition
value="Measure of service covered by the plan benefit expressed in a how many days are covered in a month."/>
</concept>
<concept>
<code value="daysperyr"/>
<display value="Days per year"/>
<definition
value="Measure of service covered by the plan benefit expressed in a how many days are covered in a year."/>
</concept>
<concept>
<code value="mthsperyr"/>
<display value="Months per year"/>
<definition
value="Measure of service covered by the plan benefit expressed in a how many month are covered in a year."/>
</concept>
<concept>
<code value="visitsperday"/>
<display value="Visits per day"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of visits covered per day."/>
</concept>
<concept>
<code value="visitsperweek"/>
<display value="Visits per week"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of visits covered per week."/>
</concept>
<concept>
<code value="visitspermth"/>
<display value="Visits per month"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of visits covered per month."/>
</concept>
<concept>
<code value="visitsperyr"/>
<display value="Visits per year"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of visits covered per year."/>
</concept>
<concept>
<code value="lifetimevisits"/>
<display value="Lifetime visits"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of visits covered through lifetime."/>
</concept>
<concept>
<code value="txperweek"/>
<display value="Treatments per week"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a week."/>
</concept>
<concept>
<code value="txpermnth"/>
<display value="Treatments per month"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a month."/>
</concept>
<concept>
<code value="txlifetime"/>
<display value="Lifetime treatments"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of treatment actions covered in a lifetime."/>
</concept>
<concept>
<code value="admitslifetime"/>
<display value="Lifetime admissions"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number admission actions covered through lifetime."/>
</concept>
<concept>
<code value="procperwk"/>
<display value="Procedures per week"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number procedure covered per week."/>
</concept>
<concept>
<code value="procpermnth"/>
<display value="Procedures per month"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number procedure covered per month."/>
</concept>
<concept>
<code value="procperyr"/>
<display value="Procedures per year"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number procedure covered per year."/>
</concept>
<concept>
<code value="proclifetime"/>
<display value="Lifetime procedures"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number procedure covered per lifetime."/>
</concept>
<concept>
<code value="daysperadmission"/>
<display value="Days per admission"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of days covered for each individual admission."/>
</concept>
<concept>
<code value="procperepi"/>
<display value="Procedures per episode"/>
<definition
value="Measure of service covered by the plan benefit expressed in a definite number of procedures covered for each individual treatment episode."/>
</concept>
<concept>
<code value="cat"/>
<display value="Catastrophic"/>
<definition
value="'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."/>
</concept>
<concept>
<code value="bronze"/>
<display value="Bronze"/>
<definition
value="'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."/>
</concept>
<concept>
<code value="bronzeexp"/>
<display value="Expanded Bronze"/>
<definition
value="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."/>
</concept>
<concept>
<code value="silver"/>
<display value="Silver"/>
<definition
value="'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."/>
</concept>
<concept>
<code value="gold"/>
<display value="Gold"/>
<definition
value="'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."/>
</concept>
<concept>
<code value="platinum"/>
<display value="Platinum"/>
<definition
value="'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."/>
</concept>
<concept>
<code value="lowded"/>
<display value="Low deductible"/>
<definition
value="A health insurance plan with higher premiums and lower out of pocket cost than a traditional health plan."/>
</concept>
<concept>
<code value="highded"/>
<display value="High deductible"/>
<definition
value="A health insurance plan with lower premiums and higher out of pocket cost than a traditional health plan."/>
</concept>
</CodeSystem>
IG © 2022+ HL7 International / Patient Administration. Package hl7.fhir.uv.vhdir#1.0.0 based on FHIR 4.0.1. Generated 2024-08-26
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