HL7 Terminology (THO)
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This page is part of the HL7 Terminology (v4.0.0: 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

: x_RoleClassPayeePolicyRelationship - JSON Representation

Active as of 2014-03-26

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{
  "resourceType" : "ValueSet",
  "id" : "v3-xRoleClassPayeePolicyRelationship",
  "language" : "en",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><ul><li>Include these codes as defined in <a href=\"CodeSystem-v3-RoleClass.html\"><code>http://terminology.hl7.org/CodeSystem/v3-RoleClass</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-v3-RoleClass.html#v3-RoleClass-COVPTY\">COVPTY</a></td><td>covered party</td><td>A role class played by a person who receives benefit coverage under the terms of a particular insurance policy. The underwriter of that policy is the scoping entity. The covered party receives coverage because of some contractual or other relationship with the holder of that policy.<br/><br/>*Discussion:*This reason for coverage is captured in 'Role.code' and a relationship link with type code of indirect authority should be included using the policy holder role as the source, and the covered party role as the target.<br/><br/>Note that a particular policy may cover several individuals one of whom may be, but need not be, the policy holder. Thus the notion of covered party is a role that is distinct from that of the policy holder.</td></tr><tr><td><a href=\"CodeSystem-v3-RoleClass.html#v3-RoleClass-GUAR\">GUAR</a></td><td>guarantor</td><td>A person or organization (player) that serves as a financial guarantor for another person or organization (scoper).</td></tr><tr><td><a href=\"CodeSystem-v3-RoleClass.html#v3-RoleClass-POLHOLD\">POLHOLD</a></td><td>policy holder</td><td>A role played by a person or organization that holds an insurance policy. The underwriter of that policy is the scoping entity.<br/><br/>*Discussion:*The identifier of the policy is captured in 'Role.id' when the Role is a policy holder.<br/><br/>A particular policy may cover several individuals one of whom may be, but need not be, the policy holder. Thus the notion of covered party is a role that is distinct from that of the policy holder.</td></tr><tr><td><a href=\"CodeSystem-v3-RoleClass.html#v3-RoleClass-PROV\">PROV</a></td><td>healthcare provider</td><td>An Entity (player) that is authorized to provide health care services by some authorizing agency (scoper).</td></tr><tr><td><a href=\"CodeSystem-v3-RoleClass.html#v3-RoleClass-PRS\">PRS</a></td><td>personal relationship</td><td>Links two entities with classCode PSN (person) in a personal relationship. The character of the relationship must be defined by a PersonalRelationshipRoleType code. The player and scoper are determined by PersonalRelationshipRoleType code as well.</td></tr></table></li></ul></div>"
  },
  "extension" : [
    {
      "extension" : [
        {
          "url" : "name",
          "valueString" : "Name:Class"
        },
        {
          "url" : "value",
          "valueString" : "payeePolicyRelationship"
        }
      ],
      "url" : "http://terminology.hl7.org/StructureDefinition/ext-mif-assocConceptProp"
    },
    {
      "extension" : [
        {
          "url" : "name",
          "valueString" : "Name:Role:player:Entity"
        },
        {
          "url" : "value",
          "valueString" : "payee&"
        }
      ],
      "url" : "http://terminology.hl7.org/StructureDefinition/ext-mif-assocConceptProp"
    },
    {
      "extension" : [
        {
          "url" : "name",
          "valueString" : "Name:Role:scoper:Entity"
        },
        {
          "url" : "value",
          "valueString" : "scoping&"
        }
      ],
      "url" : "http://terminology.hl7.org/StructureDefinition/ext-mif-assocConceptProp"
    },
    {
      "extension" : [
        {
          "url" : "name",
          "valueString" : "Sort:Entity:playedRole:Role"
        },
        {
          "url" : "value",
          "valueString" : "AAAACA___"
        }
      ],
      "url" : "http://terminology.hl7.org/StructureDefinition/ext-mif-assocConceptProp"
    },
    {
      "extension" : [
        {
          "url" : "name",
          "valueString" : "Sort:Entity:scopedRole:Role"
        },
        {
          "url" : "value",
          "valueString" : "AAAACA___"
        }
      ],
      "url" : "http://terminology.hl7.org/StructureDefinition/ext-mif-assocConceptProp"
    }
  ],
  "url" : "http://terminology.hl7.org/ValueSet/v3-xRoleClassPayeePolicyRelationship",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.1.11.19395"
    }
  ],
  "version" : "2.0.0",
  "name" : "XRoleClassPayeePolicyRelationship",
  "title" : "x_RoleClassPayeePolicyRelationship",
  "status" : "active",
  "date" : "2014-03-26",
  "description" : "The specification of the relationship of the Payee to the invoice. Can be used in cases when an insurer is not directly paying the healthcare provider (as payee) but reimbursing the party that paid the invoice/claim.",
  "compose" : {
    "include" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleClass",
        "concept" : [
          {
            "code" : "COVPTY"
          },
          {
            "code" : "GUAR"
          },
          {
            "code" : "POLHOLD"
          },
          {
            "code" : "PROV"
          },
          {
            "code" : "PRS"
          }
        ]
      }
    ]
  }
}