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 |
<ValueSet xmlns="http://hl7.org/fhir">
<id value="benefit-type"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ValueSet benefit-type</b></p><a name="benefit-type"> </a><a name="hcbenefit-type"> </a><a name="benefit-type-en-US"> </a><ul><li>Include these codes as defined in <a href="CodeSystem-payercharacteristics.html"><code>http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-pcpov">pcpov</a></td><td style="color: #cccccc">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><a href="CodeSystem-payercharacteristics.html#payercharacteristics-specialistov">specialistov</a></td><td style="color: #cccccc">Specialist Office Visit</td><td>Covered healthcare service rendered to a patient by a specialty provider.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-mlpov">mlpov</a></td><td style="color: #cccccc">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><a href="CodeSystem-payercharacteristics.html#payercharacteristics-outpatient">outpatient</a></td><td style="color: #cccccc">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><a href="CodeSystem-payercharacteristics.html#payercharacteristics-outpatstx">outpatstx</a></td><td style="color: #cccccc">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><a href="CodeSystem-payercharacteristics.html#payercharacteristics-hospserv">hospserv</a></td><td style="color: #cccccc">Hospice Services</td><td>Benefit plan covers hospice services.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-routinedental">routinedental</a></td><td style="color: #cccccc">Routine Dental Services (Adult)</td><td>Benefit plan covers routine dental services.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-infertilitytx">infertilitytx</a></td><td style="color: #cccccc">Infertility Treatment</td><td>Benefit plan covers eligible infertility treatment services.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-ltnhc">ltnhc</a></td><td style="color: #cccccc">Long-Term/Custodial Nursing Home Care</td><td>Long-Term/Custodial Nursing Home Care.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-privatenurse">privatenurse</a></td><td style="color: #cccccc">Private-Duty Nursing</td><td>Private-Duty Nursing.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-routineeye">routineeye</a></td><td style="color: #cccccc">Routine Eye Exam (Adult)</td><td>Routine Eye Exam (Adult).</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-ucservice">ucservice</a></td><td style="color: #cccccc">Urgent Care Centers or Facilities</td><td>Urgent Care Centers or Facilities.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-homehealth">homehealth</a></td><td style="color: #cccccc">Home Health</td><td>Home health services insurance coverage.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-erservice">erservice</a></td><td style="color: #cccccc">Emergency Room Services</td><td>Emergency Room Services.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-ambulance">ambulance</a></td><td style="color: #cccccc">Emergency Room Services</td><td>Emergency Room Services.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-inpatienthospital">inpatienthospital</a></td><td style="color: #cccccc">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><a href="CodeSystem-payercharacteristics.html#payercharacteristics-inpatientprovider">inpatientprovider</a></td><td style="color: #cccccc">Inpatient Physician and Surgical Services</td><td>A healthcare provider who is delivering healthcare services in a hospital environment.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-bariatricsurg">bariatricsurg</a></td><td style="color: #cccccc">Bariatric Surgery</td><td>Bariatric surgery service Skilled nursing service (qualifier value).</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-cosmeticsurg">cosmeticsurg</a></td><td style="color: #cccccc">Cosmetic Surgery</td><td>Cosmetic surgery service Skilled nursing service (qualifier value).</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-skillednursing">skillednursing</a></td><td style="color: #cccccc">Skilled Nursing Facility</td><td>Skilled nursing service (qualifier value).</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-ppnatalcare">ppnatalcare</a></td><td style="color: #cccccc">Prenatal and Postnatal Care</td><td>Prenatal and Postnatal services.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-maternitycare">maternitycare</a></td><td style="color: #cccccc">Delivery and All Inpatient Services for Maternity Care</td><td>All maternity care services.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-menthlthoutp">menthlthoutp</a></td><td style="color: #cccccc">Mental/Behavioral Health Outpatient Services</td><td>Mental health service delivered in an outpatient setting.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-menthlthinp">menthlthinp</a></td><td style="color: #cccccc">Mental/Behavioral Health Inpatient Services</td><td>Mental health service delivered in an hospital or inpatient facility setting.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-sadoutp">sadoutp</a></td><td style="color: #cccccc">Substance Abuse Disorder Outpatient Services</td><td>Substance abuse related services delivered in a outpatient setting.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-sadinp">sadinp</a></td><td style="color: #cccccc">Substance Abuse Disorder Inpatient Services</td><td>Substance abuse related services delivered in a inpatient setting.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-drggenric">drggenric</a></td><td style="color: #cccccc">Generic Drugs</td><td>Generic drugs eligible benefits.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-drgbrand">drgbrand</a></td><td style="color: #cccccc">Preferred Brand Drugs</td><td>Preferred brand drugs eligible benefits.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-drgnonpreferred">drgnonpreferred</a></td><td style="color: #cccccc">Non-Preferred Brand Drugs</td><td>Non-Preferred drugs brands eligible benefits.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-drgspecialty">drgspecialty</a></td><td style="color: #cccccc">Specialty Drugs</td><td>Benefit plan covers specialty drugs.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-rehaboutp">rehaboutp</a></td><td style="color: #cccccc">Outpatient Rehabilitation Services</td><td>Benefit plan covers outpatient rehabilitation services.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-servicehablitation">servicehablitation</a></td><td style="color: #cccccc">Habilitation Services</td><td>Habilitation Services.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-chiro">chiro</a></td><td style="color: #cccccc">Chiropractic Care</td><td>Benefit plan covers chiropractor eligible benefits.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-dme">dme</a></td><td style="color: #cccccc">Durable Medical Equipment</td><td>Benefit plan covers Durable medical equipment eligible benefits.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-hearingaids">hearingaids</a></td><td style="color: #cccccc">Hearing Aids</td><td>Benefit plan covers hearing aids.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-imgctpetmri">imgctpetmri</a></td><td style="color: #cccccc">Imaging (CT/PET Scans, MRIs)</td><td>Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-prev">prev</a></td><td style="color: #cccccc">Preventive Care/Screening/Immunization</td><td>Routine healthcare services to prevent health related problems eligible benefits.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-rtnpod">rtnpod</a></td><td style="color: #cccccc">Routine Foot Care</td><td>Routine Foot Care.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-acupuncture">acupuncture</a></td><td style="color: #cccccc">Acupuncture</td><td>Benefit plan covers acupuncture treatment.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-weightloss">weightloss</a></td><td style="color: #cccccc">Weight Loss Programs</td><td>Benefit plan covers weight loss services eligible benefits.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-rtneyechld">rtneyechld</a></td><td style="color: #cccccc">Routine Eye Exam for Children</td><td>Routine eye exam for children eligible benefits.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-glasseschld">glasseschld</a></td><td style="color: #cccccc">Eye Glasses for Children</td><td>Eye glasses children eligible benefits.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-rtndntlchld">rtndntlchld</a></td><td style="color: #cccccc">Dental Check-Up for Children</td><td>Dental Check-Up for Children.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-speachthpy">speachthpy</a></td><td style="color: #cccccc">Rehabilitative Speech Therapy</td><td>Benefit plan covers rehabilitative speech therapy eligible benefits.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-rehaboccandpt">rehaboccandpt</a></td><td style="color: #cccccc">Rehabilitative Occupational and Rehabilitative Physical Therapy</td><td>Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-wellbaby">wellbaby</a></td><td style="color: #cccccc">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><a href="CodeSystem-payercharacteristics.html#payercharacteristics-laboutp">laboutp</a></td><td style="color: #cccccc">Laboratory Outpatient and Professional Services</td><td>Benefit plan covers laboratory testing and related professional services received as outpatient.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-imagingdx">imagingdx</a></td><td style="color: #cccccc">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><a href="CodeSystem-payercharacteristics.html#payercharacteristics-dntlbaschld">dntlbaschld</a></td><td style="color: #cccccc">Basic Dental Care – Child</td><td>Benefit plan covers diagnostic basic dental care.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-orthochld">orthochld</a></td><td style="color: #cccccc">Orthodontia – Child</td><td>Benefit plan covers orthodontia for children.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-dntlmajchld">dntlmajchld</a></td><td style="color: #cccccc">Major Dental Care – Child</td><td>Benefit plan covers major dental care for children.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-dntlbasadlt">dntlbasadlt</a></td><td style="color: #cccccc">Basic Dental Care – Adult</td><td>Benefit plan covers basic dental care for adults.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-orthodadlt">orthodadlt</a></td><td style="color: #cccccc">Orthodontia – Adult</td><td>Benefits plan covers services provided that are required for orthodontic purposes for an adult.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-dntlmajadlt">dntlmajadlt</a></td><td style="color: #cccccc">Major Dental Care – Adult</td><td>Benefit plan covers major dental care for adult.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-abortion">abortion</a></td><td style="color: #cccccc">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><a href="CodeSystem-payercharacteristics.html#payercharacteristics-transplant">transplant</a></td><td style="color: #cccccc">Transplant</td><td>Benefit plan covers transplant related services.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-accdntl">accdntl</a></td><td style="color: #cccccc">Accidental Dental</td><td>Benefit plan covers dental care services related to an accident.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-dialysis">dialysis</a></td><td style="color: #cccccc">Dialysis</td><td>The plan benefit covers services used to treat end stage renal disease.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-testallrgy">testallrgy</a></td><td style="color: #cccccc">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><a href="CodeSystem-payercharacteristics.html#payercharacteristics-chemotherapy">chemotherapy</a></td><td style="color: #cccccc">Chemotherapy</td><td>The plan benefits cover services the use of drugs and approved chemicals to treat disease.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-radiation">radiation</a></td><td style="color: #cccccc">Radiation</td><td>The plan benefits cover services the use radiation to treat disease.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-edudiab">edudiab</a></td><td style="color: #cccccc">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><a href="CodeSystem-payercharacteristics.html#payercharacteristics-prosthetic">prosthetic</a></td><td style="color: #cccccc">Prosthetic Devices</td><td>Plan benefit covers services related to prosthesis devices.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-infusiontx">infusiontx</a></td><td style="color: #cccccc">Infusion Therapy</td><td>Plan benefit covers services related to infusion therapy.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-tmjtx">tmjtx</a></td><td style="color: #cccccc">Treatment for Temporomandibular Joint Disorders</td><td>Plan benefit covers services related to treatment of Temporomandibular Joint disorder.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-nutrition">nutrition</a></td><td style="color: #cccccc">Nutritional Counseling</td><td>Nutritional Counseling.</td></tr><tr><td><a href="CodeSystem-payercharacteristics.html#payercharacteristics-reconsurg">reconsurg</a></td><td style="color: #cccccc">Reconstructive Surgery</td><td>Plan benefit covers services related to reconstructive surgery.</td></tr></table></li></ul></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="pa"/>
</extension>
<url value="http://hl7.org/fhir/uv/vhdir/ValueSet/benefit-type"/>
<version value="1.0.0"/>
<name value="VhDirBenefitType"/>
<title value="VhDir Benefit Type"/>
<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 value set defines a set of codes that indicate the type of benefit in a product/plan."/>
<jurisdiction>
<coding>
<system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
<code value="001"/>
<display value="World"/>
</coding>
</jurisdiction>
<copyright
value="Used by permission of HL7 International all rights reserved Creative Commons License"/>
<compose>
<include>
<system
value="http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics"/>
<concept>
<code value="pcpov"/>
</concept>
<concept>
<code value="specialistov"/>
</concept>
<concept>
<code value="mlpov"/>
</concept>
<concept>
<code value="outpatient"/>
</concept>
<concept>
<code value="outpatstx"/>
</concept>
<concept>
<code value="hospserv"/>
</concept>
<concept>
<code value="routinedental"/>
</concept>
<concept>
<code value="infertilitytx"/>
</concept>
<concept>
<code value="ltnhc"/>
</concept>
<concept>
<code value="privatenurse"/>
</concept>
<concept>
<code value="routineeye"/>
</concept>
<concept>
<code value="ucservice"/>
</concept>
<concept>
<code value="homehealth"/>
</concept>
<concept>
<code value="erservice"/>
</concept>
<concept>
<code value="ambulance"/>
</concept>
<concept>
<code value="inpatienthospital"/>
</concept>
<concept>
<code value="inpatientprovider"/>
</concept>
<concept>
<code value="bariatricsurg"/>
</concept>
<concept>
<code value="cosmeticsurg"/>
</concept>
<concept>
<code value="skillednursing"/>
</concept>
<concept>
<code value="ppnatalcare"/>
</concept>
<concept>
<code value="maternitycare"/>
</concept>
<concept>
<code value="menthlthoutp"/>
</concept>
<concept>
<code value="menthlthinp"/>
</concept>
<concept>
<code value="sadoutp"/>
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<concept>
<code value="sadinp"/>
</concept>
<concept>
<code value="drggenric"/>
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<concept>
<code value="drgbrand"/>
</concept>
<concept>
<code value="drgnonpreferred"/>
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<concept>
<code value="drgspecialty"/>
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<concept>
<code value="rehaboutp"/>
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<concept>
<code value="servicehablitation"/>
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<concept>
<code value="chiro"/>
</concept>
<concept>
<code value="dme"/>
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<concept>
<code value="hearingaids"/>
</concept>
<concept>
<code value="imgctpetmri"/>
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<concept>
<code value="prev"/>
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<concept>
<code value="rtnpod"/>
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<concept>
<code value="acupuncture"/>
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<concept>
<code value="weightloss"/>
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<concept>
<code value="rtneyechld"/>
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<concept>
<code value="glasseschld"/>
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<concept>
<code value="rtndntlchld"/>
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<code value="speachthpy"/>
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<concept>
<code value="rehaboccandpt"/>
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<concept>
<code value="wellbaby"/>
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<concept>
<code value="laboutp"/>
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<concept>
<code value="imagingdx"/>
</concept>
<concept>
<code value="dntlbaschld"/>
</concept>
<concept>
<code value="orthochld"/>
</concept>
<concept>
<code value="dntlmajchld"/>
</concept>
<concept>
<code value="dntlbasadlt"/>
</concept>
<concept>
<code value="orthodadlt"/>
</concept>
<concept>
<code value="dntlmajadlt"/>
</concept>
<concept>
<code value="abortion"/>
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<concept>
<code value="transplant"/>
</concept>
<concept>
<code value="accdntl"/>
</concept>
<concept>
<code value="dialysis"/>
</concept>
<concept>
<code value="testallrgy"/>
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<concept>
<code value="chemotherapy"/>
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<concept>
<code value="radiation"/>
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<concept>
<code value="edudiab"/>
</concept>
<concept>
<code value="prosthetic"/>
</concept>
<concept>
<code value="infusiontx"/>
</concept>
<concept>
<code value="tmjtx"/>
</concept>
<concept>
<code value="nutrition"/>
</concept>
<concept>
<code value="reconsurg"/>
</concept>
</include>
</compose>
</ValueSet>
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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