This page is part of the HL7 Terminology (v1.0.0: Release) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 7.0.0. For a full list of available versions, see the Directory of published versions

Benefit cost applicability - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "applicability",
  "meta" : {
    "lastUpdated" : "2020-04-09T21:10:28.568+00:00",
    "profile" : [
      "http://hl7.org/fhir/StructureDefinition/shareablecodesystem"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n            \n      \n      <h2>Benefit cost applicability</h2>\n            \n      \n      <div>\n              \n        \n        <p>Whether the cost applies to in-network or out-of-network providers.</p>\n\n            \n      \n      </div>\n            \n      \n      <p>This code system http://terminology.hl7.org/CodeSystem/applicability defines the following codes:</p>\n            \n      \n      <table class=\"codes\">\n              \n        \n        <tr>\n                \n          \n          <td style=\"white-space:nowrap\">\n                  \n            \n            <b>Code</b>\n                \n          \n          </td>\n                \n          \n          <td>\n                  \n            \n            <b>Display</b>\n                \n          \n          </td>\n                \n          \n          <td>\n                  \n            \n            <b>Definition</b>\n                \n          \n          </td>\n              \n        \n        </tr>\n              \n        \n        <tr>\n                \n          \n          <td style=\"white-space:nowrap\">in-network\n                  \n            \n            <a name=\"insuranceplan-applicability-in-network\"> </a>\n                \n          \n          </td>\n                \n          \n          <td>In Network</td>\n                \n          \n          <td>Provider is contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates</td>\n              \n        \n        </tr>\n              \n        \n        <tr>\n                \n          \n          <td style=\"white-space:nowrap\">out-of-network\n                  \n            \n            <a name=\"insuranceplan-applicability-out-of-network\"> </a>\n                \n          \n          </td>\n                \n          \n          <td>Out of Network</td>\n                \n          \n          <td>Provider is  not contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates</td>\n              \n        \n        </tr>\n              \n        \n        <tr>\n                \n          \n          <td style=\"white-space:nowrap\">other\n                  \n            \n            <a name=\"insuranceplan-applicability-other\"> </a>\n                \n          \n          </td>\n                \n          \n          <td>Other</td>\n                \n          \n          <td>Other applicability</td>\n              \n        \n        </tr>\n            \n      \n      </table>\n          \n    \n    </div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "pa"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger" : 0
    }
  ],
  "url" : "http://terminology.hl7.org/CodeSystem/applicability",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.4.642.1.0"
    }
  ],
  "version" : "4.2.0",
  "name" : "BenefitCostApplicability",
  "title" : "Benefit cost applicability",
  "status" : "draft",
  "experimental" : false,
  "date" : "2018-06-05T14:06:02+00:00",
  "publisher" : "HL7 (FHIR Project)",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://hl7.org/fhir"
        },
        {
          "system" : "email",
          "value" : "fhir@lists.hl7.org"
        }
      ]
    },
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://hl7.org/fhir"
        },
        {
          "system" : "email",
          "value" : "fhir@lists.hl7.org"
        }
      ]
    }
  ],
  "description" : "Whether the cost applies to in-network or out-of-network providers.",
  "caseSensitive" : true,
  "valueSet" : "http://terminology.hl7.org/ValueSet/insuranceplan-applicability",
  "content" : "complete",
  "concept" : [
    {
      "code" : "in-network",
      "display" : "In Network",
      "definition" : "Provider is contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates"
    },
    {
      "code" : "out-of-network",
      "display" : "Out of Network",
      "definition" : "Provider is  not contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates"
    },
    {
      "code" : "other",
      "display" : "Other",
      "definition" : "Other applicability"
    }
  ]
}