HL7 Terminology (THO)
5.1.0 - Publication International flag

This page is part of the HL7 Terminology (v5.1.0: 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

ValueSet: x_RoleClassPayeePolicyRelationship

Official URL: http://terminology.hl7.org/ValueSet/v3-xRoleClassPayeePolicyRelationship Version: 2.0.0
Active as of 2014-03-26 Computable Name: XRoleClassPayeePolicyRelationship
Other Identifiers: id: urn:oid:2.16.840.1.113883.1.11.19395

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.

References

This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

Logical Definition (CLD)

  • Include these codes as defined in http://terminology.hl7.org/CodeSystem/v3-RoleClass
    CodeDisplayDefinition
    COVPTYcovered partyA 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.

    *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.

    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.
    GUARguarantorA person or organization (player) that serves as a financial guarantor for another person or organization (scoper).
    POLHOLDpolicy holderA role played by a person or organization that holds an insurance policy. The underwriter of that policy is the scoping entity.

    *Discussion:*The identifier of the policy is captured in 'Role.id' when the Role is a policy holder.

    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.
    PROVhealthcare providerAn Entity (player) that is authorized to provide health care services by some authorizing agency (scoper).
    PRSpersonal relationshipLinks 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.

 

Expansion

This value set contains 5 concepts

Expansion based on RoleClass v3.1.0 (CodeSystem)

CodeSystemDisplayDefinition
  COVPTYhttp://terminology.hl7.org/CodeSystem/v3-RoleClasscovered party

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.

*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.

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.

  GUARhttp://terminology.hl7.org/CodeSystem/v3-RoleClassguarantor

A person or organization (player) that serves as a financial guarantor for another person or organization (scoper).

  POLHOLDhttp://terminology.hl7.org/CodeSystem/v3-RoleClasspolicy holder

A role played by a person or organization that holds an insurance policy. The underwriter of that policy is the scoping entity.

*Discussion:*The identifier of the policy is captured in 'Role.id' when the Role is a policy holder.

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.

  PROVhttp://terminology.hl7.org/CodeSystem/v3-RoleClasshealthcare provider

An Entity (player) that is authorized to provide health care services by some authorizing agency (scoper).

  PRShttp://terminology.hl7.org/CodeSystem/v3-RoleClasspersonal relationship

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.

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code

History

DateActionCustodianAuthorComment
2022-10-18reviseTSMGMarc DuteauFixing missing metadata; up-349
2020-05-06reviseVocabulary WGTed KleinMigrated to the UTG maintenance environment and publishing tooling.
2014-03-26revise2014T1_2014-03-26_001283 (RIM release ID)Vocabulary (Woody Beeler) (no record of original request)Lock all vaue sets untouched since 2014-03-26 to trackingId 2014T1_2014_03_26