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

ManagedCarePolicy - XML Representation

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Raw xml

Source view

<ValueSet xmlns="http://hl7.org/fhir">
  <id value="v3-ManagedCarePolicy"/>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"><h2>ManagedCarePolicy</h2><div><p><strong>Definition:</strong> Government mandated program providing coverage, disability income, and vocational rehabilitation for injuries sustained in the work place or in the course of employment. Employers may either self-fund the program, purchase commercial coverage, or pay a premium to a government entity that administers the program. Employees may be required to pay premiums toward the cost of coverage as well.</p>
<p>Managed care policies specifically exclude coverage for losses insured under a disability policy, workers' compensation program, liability insurance (including automobile insurance); or for medical expenses, coverage for on-site medical clinics or for limited dental or vision benefits when these are provided under a separate policy.</p>
<p><em>Discussion:</em> Managed care policies are offered by managed care plans that contract with selected providers or health care organizations to provide comprehensive health care at a discount to covered parties and coordinate the financing and delivery of health care. Managed care uses medical protocols and procedures agreed on by the medical profession to be cost effective, also known as medical practice guidelines. Providers are typically reimbursed for covered services by a capitated amount on a per member per month basis that may reflect difference in the health status and level of services anticipated to be needed by the member.</p>
</div><ul><li>Include codes from <a href="CodeSystem-v3-ActCode.html"><code>http://terminology.hl7.org/CodeSystem/v3-ActCode</code></a> where concept  is-a  <a href="CodeSystem-v3-ActCode.html#v3-ActCode-MCPOL">MCPOL</a></li></ul></div>
  </text>
  <url value="http://terminology.hl7.org/ValueSet/v3-ManagedCarePolicy"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.1.11.19860"/>
  </identifier>
  <version value="2.0.0"/>
  <name value="ManagedCarePolicy"/>
  <title value="ManagedCarePolicy"/>
  <status value="active"/>
  <date value="2014-03-26T00:00:00-04:00"/>
  <description
               value="**Definition:** Government mandated program providing coverage, disability income, and vocational rehabilitation for injuries sustained in the work place or in the course of employment. Employers may either self-fund the program, purchase commercial coverage, or pay a premium to a government entity that administers the program. Employees may be required to pay premiums toward the cost of coverage as well.

Managed care policies specifically exclude coverage for losses insured under a disability policy, workers&#39; compensation program, liability insurance (including automobile insurance); or for medical expenses, coverage for on-site medical clinics or for limited dental or vision benefits when these are provided under a separate policy.

*Discussion:* Managed care policies are offered by managed care plans that contract with selected providers or health care organizations to provide comprehensive health care at a discount to covered parties and coordinate the financing and delivery of health care. Managed care uses medical protocols and procedures agreed on by the medical profession to be cost effective, also known as medical practice guidelines. Providers are typically reimbursed for covered services by a capitated amount on a per member per month basis that may reflect difference in the health status and level of services anticipated to be needed by the member."/>
  <compose>
    <include>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
      <filter>
        <property value="concept"/>
        <op value="is-a"/>
        <value value="MCPOL"/>
      </filter>
    </include>
  </compose>
</ValueSet>