HL7 Terminology
1.0.0 - Publication

This page is part of the HL7 Terminology (v1.0.0: Release) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

PayorParticipationFunction

Summary

Defining URL:http://terminology.hl7.org/ValueSet/v3-PayorParticipationFunction
Version:2.0.0
Name:PayorParticipationFunction
Status:Active
Title:PayorParticipationFunction
Definition:

Definition: Set of codes indicating the manner in which payors participate in a policy or program.</

OID:2.16.840.1.113883.1.11.19906 (for OID based terminology systems)
Source Resource:XML / JSON / Turtle

References

This value set is not used

Content Logical Definition

Logical Definition (CLD)

 

Expansion

This value set contains 6 concepts

Expansion based on ParticipationFunction v2.0.0 (CodeSystem)

All codes from system http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction

LvlCodeDisplayDefinition
0_PayorParticipationFunctionPayorParticipationFunction**Definition:** Set of codes indicating the manner in which payors participate in a policy or program.</
1  CLMADJclaims adjudication**Definition:** Manages all operations required to adjudicate fee for service claims or managed care encounter reports.
1  ENROLLenrollment broker**Definition:** Managing the enrollment of covered parties.
1  FFSMGTffs management**Definition:** Managing all operations required to administer a fee for service or indemnity health plan including enrolling covered parties and providing customer service, provider contracting, claims payment, care management and utilization review.
1  MCMGTmanaged care management**Definition:** Managing all operations required to administer a managed care plan including enrolling covered parties and providing customer service,, provider contracting, claims payment, care management and utilization review.
1  PROVMGTprovider management**Definition:** Managing provider contracting, provider services, credentialing, profiling, performance measures, and ensuring network adequacy.
1  UMGTutilization management**Definition:** Managing utilization of services by ensuring that providers adhere to, e.g., payeraTMs clinical protocols for medical appropriateness and standards of medical necessity. May include management of authorizations for services and referrals.

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
Source 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

DateActionAuthorCustodianComment
2020-05-06reviseTed KleinVocabulary WGMigrated to the UTG maintenance environment and publishing tooling.
2014-03-26reviseVocabulary (Woody Beeler) (no record of original request)2014T1_2014-03-26_001283 (RIM release ID)Lock all vaue sets untouched since 2014-03-26 to trackingId 2014T1_2014_03_26