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 - XML Representation

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

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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"><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>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="pa"/>
  </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="0.1.0"/>
  <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>