HL7 Terminology (THO)
5.2.0 - Publication International flag

This page is part of the HL7 Terminology (v5.2.0: Release) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

: Benefit cost applicability - JSON Representation

Draft as of 2018-06-05 Maturity Level: 0

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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\"><p>This code system <code>http://terminology.hl7.org/CodeSystem/applicability</code> 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=\"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=\"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=\"applicability-other\"> </a></td><td>Other</td><td>Other applicability</td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "pa"
    },
    {
      "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" : "0.1.0",
  "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"
    }
  ]
}