This page is part of the HL7 Terminology (v1.0.0: Release) based on FHIR R4. The current version which supercedes this version is 5.2.0. For a full list of available versions, see the Directory of published versions

Benefit cost applicability - XML Representation

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Raw xml

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="applicability"/>
  <meta>
    <lastUpdated value="2020-04-09T21:10:28.568+00:00"/>
    <profile value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
            
      
      <h2>Benefit cost applicability</h2>
            
      
      <div>
              
        
        <p>Whether the cost applies to in-network or out-of-network providers.</p>

            
      
      </div>
            
      
      <p>This code system http://terminology.hl7.org/CodeSystem/applicability 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">in-network
                  
            
            <a name="insuranceplan-applicability-in-network"> </a>
                
          
          </td>
                
          
          <td>In Network</td>
                
          
          <td>Provider is contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates</td>
              
        
        </tr>
              
        
        <tr>
                
          
          <td style="white-space:nowrap">out-of-network
                  
            
            <a name="insuranceplan-applicability-out-of-network"> </a>
                
          
          </td>
                
          
          <td>Out of Network</td>
                
          
          <td>Provider is  not contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates</td>
              
        
        </tr>
              
        
        <tr>
                
          
          <td style="white-space:nowrap">other
                  
            
            <a name="insuranceplan-applicability-other"> </a>
                
          
          </td>
                
          
          <td>Other</td>
                
          
          <td>Other applicability</td>
              
        
        </tr>
            
      
      </table>
          
    
    </div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="pa"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="0"/>
  </extension>
  <url value="http://terminology.hl7.org/CodeSystem/applicability"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.1.0"/>
  </identifier>
  <version value="4.2.0"/>
  <name value="BenefitCostApplicability"/>
  <title value="Benefit cost applicability"/>
  <status value="draft"/>
  <experimental value="false"/>
  <date value="2018-06-05T14:06:02+00:00"/>
  <publisher value="HL7 (FHIR Project)"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://hl7.org/fhir"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="fhir@lists.hl7.org"/>
    </telecom>
  </contact>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://hl7.org/fhir"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="fhir@lists.hl7.org"/>
    </telecom>
  </contact>
  <description
               value="Whether the cost applies to in-network or out-of-network providers."/>
  <caseSensitive value="true"/>
  <valueSet
            value="http://terminology.hl7.org/ValueSet/insuranceplan-applicability"/>
  <content value="complete"/>
  <concept>
    <code value="in-network"/>
    <display value="In Network"/>
    <definition
                value="Provider is contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates"/>
  </concept>
  <concept>
    <code value="out-of-network"/>
    <display value="Out of Network"/>
    <definition
                value="Provider is  not contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates"/>
  </concept>
  <concept>
    <code value="other"/>
    <display value="Other"/>
    <definition value="Other applicability"/>
  </concept>
</CodeSystem>