| Package | hl7.fhir.uv.vhdir |
| Resource Type | ValueSet |
| Id | benefit-type |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/uv/vhdir/https://build.fhir.org/ig/HL7/VhDir/ValueSet-benefit-type.html |
| URL | http://hl7.org/fhir/uv/vhdir/ValueSet/benefit-type |
| Version | 1.0.0 |
| Status | active |
| Date | 2018-02-21 |
| Name | VhDirBenefitType |
| Title | VhDir Benefit Type |
| Realm | uv |
| Authority | hl7 |
| Description | This value set defines a set of codes that indicate the type of benefit in a product/plan. |
| Copyright | Used by permission of HL7 International all rights reserved Creative Commons License |
| StructureDefinition | |
| vhdir-insuranceplan | VhDir Insurance Plan |
| CodeSystem | |
| payercharacteristics | VhDir Payer Characteristics Code System |
Note: links and images are rebased to the (stated) source
Generated Narrative: ValueSet benefit-type
http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics| Code | Display | Definition |
| pcpov | Primary Care Visit to Treat an Injury or Illness | Benefit plan covers services rendered by a primary care physician during an office visit with the purpose to treat injury or illness, except for preventive care services. |
| specialistov | Specialist Office Visit | Covered healthcare service rendered to a patient by a specialty provider. |
| mlpov | Other Practitioner Office Visit (Nurse, Physician Assistant) - Mid Level Professional | Benefit plan covers covered health related services rendered by a practioner other than MD or DO and referred to as other practitioner. |
| outpatient | Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | Benefit plan covers health related services rendered to patient at an outpatient facility, outside of a facility that requires a patient admission. |
| outpatstx | Outpatient Surgery Physician/Surgical Services | Benefit plan covers surgical services rendered to patient outside of a facility admission, referred to as outpatient. |
| hospserv | Hospice Services | Benefit plan covers hospice services. |
| routinedental | Routine Dental Services (Adult) | Benefit plan covers routine dental services. |
| infertilitytx | Infertility Treatment | Benefit plan covers eligible infertility treatment services. |
| ltnhc | Long-Term/Custodial Nursing Home Care | Long-Term/Custodial Nursing Home Care. |
| privatenurse | Private-Duty Nursing | Private-Duty Nursing. |
| routineeye | Routine Eye Exam (Adult) | Routine Eye Exam (Adult). |
| ucservice | Urgent Care Centers or Facilities | Urgent Care Centers or Facilities. |
| homehealth | Home Health | Home health services insurance coverage. |
| erservice | Emergency Room Services | Emergency Room Services. |
| ambulance | Emergency Room Services | Emergency Room Services. |
| inpatienthospital | Inpatient Hospital Services (e.g., Hospital Stay) | A person who is hospitalized for at least one night to receive treatment or participate in a study. |
| inpatientprovider | Inpatient Physician and Surgical Services | A healthcare provider who is delivering healthcare services in a hospital environment. |
| bariatricsurg | Bariatric Surgery | Bariatric surgery service Skilled nursing service (qualifier value). |
| cosmeticsurg | Cosmetic Surgery | Cosmetic surgery service Skilled nursing service (qualifier value). |
| skillednursing | Skilled Nursing Facility | Skilled nursing service (qualifier value). |
| ppnatalcare | Prenatal and Postnatal Care | Prenatal and Postnatal services. |
| maternitycare | Delivery and All Inpatient Services for Maternity Care | All maternity care services. |
| menthlthoutp | Mental/Behavioral Health Outpatient Services | Mental health service delivered in an outpatient setting. |
| menthlthinp | Mental/Behavioral Health Inpatient Services | Mental health service delivered in an hospital or inpatient facility setting. |
| sadoutp | Substance Abuse Disorder Outpatient Services | Substance abuse related services delivered in a outpatient setting. |
| sadinp | Substance Abuse Disorder Inpatient Services | Substance abuse related services delivered in a inpatient setting. |
| drggenric | Generic Drugs | Generic drugs eligible benefits. |
| drgbrand | Preferred Brand Drugs | Preferred brand drugs eligible benefits. |
| drgnonpreferred | Non-Preferred Brand Drugs | Non-Preferred drugs brands eligible benefits. |
| drgspecialty | Specialty Drugs | Benefit plan covers specialty drugs. |
| rehaboutp | Outpatient Rehabilitation Services | Benefit plan covers outpatient rehabilitation services. |
| servicehablitation | Habilitation Services | Habilitation Services. |
| chiro | Chiropractic Care | Benefit plan covers chiropractor eligible benefits. |
| dme | Durable Medical Equipment | Benefit plan covers Durable medical equipment eligible benefits. |
| hearingaids | Hearing Aids | Benefit plan covers hearing aids. |
| imgctpetmri | Imaging (CT/PET Scans, MRIs) | Benefit plan covers advances imaging techniques services (CT/PET Scans, MRIs) eligible services. |
| prev | Preventive Care/Screening/Immunization | Routine healthcare services to prevent health related problems eligible benefits. |
| rtnpod | Routine Foot Care | Routine Foot Care. |
| acupuncture | Acupuncture | Benefit plan covers acupuncture treatment. |
| weightloss | Weight Loss Programs | Benefit plan covers weight loss services eligible benefits. |
| rtneyechld | Routine Eye Exam for Children | Routine eye exam for children eligible benefits. |
| glasseschld | Eye Glasses for Children | Eye glasses children eligible benefits. |
| rtndntlchld | Dental Check-Up for Children | Dental Check-Up for Children. |
| speachthpy | Rehabilitative Speech Therapy | Benefit plan covers rehabilitative speech therapy eligible benefits. |
| rehaboccandpt | Rehabilitative Occupational and Rehabilitative Physical Therapy | Benefit plan covers rehabilitative occupational and rehabilitative physical eligible benefits. |
| wellbaby | Well Baby Visits and Care | Regularly scheduled, preventive care services, including immunizations, provided to children up to an age as specified by a health insurance company or mandated by a government agency. |
| laboutp | Laboratory Outpatient and Professional Services | Benefit plan covers laboratory testing and related professional services received as outpatient. |
| imagingdx | X-rays and Diagnostic Imaging | Benefit plan covers diagnostic imaging procedures that produce images of internal structures of the human body and uses radiation to diagnose and treat diseases. |
| dntlbaschld | Basic Dental Care – Child | Benefit plan covers diagnostic basic dental care. |
| orthochld | Orthodontia – Child | Benefit plan covers orthodontia for children. |
| dntlmajchld | Major Dental Care – Child | Benefit plan covers major dental care for children. |
| dntlbasadlt | Basic Dental Care – Adult | Benefit plan covers basic dental care for adults. |
| orthodadlt | Orthodontia – Adult | Benefits plan covers services provided that are required for orthodontic purposes for an adult. |
| dntlmajadlt | Major Dental Care – Adult | Benefit plan covers major dental care for adult. |
| abortion | Abortion for Which Public Funding is Prohibited | Benefit plan covers services for abortion for which public funding is prohibited. |
| transplant | Transplant | Benefit plan covers transplant related services. |
| accdntl | Accidental Dental | Benefit plan covers dental care services related to an accident. |
| dialysis | Dialysis | The plan benefit covers services used to treat end stage renal disease. |
| testallrgy | Allergy Testing | The plan benefits covers services for diagnostic procedures ordered or performed to evaluate whether a sensitivity to a substance is present. This test may be associated with specimen collection and/or substance administration challenge activities. |
| chemotherapy | Chemotherapy | The plan benefits cover services the use of drugs and approved chemicals to treat disease. |
| radiation | Radiation | The plan benefits cover services the use radiation to treat disease. |
| edudiab | Diabetes Education | The plan benefits cover services related to instruction or training that encourages behaviors most likely to optimize health potentials through information about diabetes; facilitates the prevention of diabetes. |
| prosthetic | Prosthetic Devices | Plan benefit covers services related to prosthesis devices. |
| infusiontx | Infusion Therapy | Plan benefit covers services related to infusion therapy. |
| tmjtx | Treatment for Temporomandibular Joint Disorders | Plan benefit covers services related to treatment of Temporomandibular Joint disorder. |
| nutrition | Nutritional Counseling | Nutritional Counseling. |
| reconsurg | Reconstructive Surgery | Plan benefit covers services related to reconstructive surgery. |
{
"resourceType": "ValueSet",
"id": "benefit-type",
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "pa"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 2,
"_valueInteger": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical": "http://hl7.org/fhir/uv/vhdir/ImplementationGuide/hl7.fhir.uv.vhdir"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "trial-use",
"_valueCode": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical": "http://hl7.org/fhir/uv/vhdir/ImplementationGuide/hl7.fhir.uv.vhdir"
}
]
}
}
],
"url": "http://hl7.org/fhir/uv/vhdir/ValueSet/benefit-type",
"version": "1.0.0",
"name": "VhDirBenefitType",
"title": "VhDir Benefit Type",
"status": "active",
"experimental": false,
"date": "2018-02-21",
"publisher": "HL7 International / Patient Administration",
"contact": [
{
"name": "HL7 International / Patient Administration",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/pafm"
},
{
"system": "email",
"value": "pafm@lists.HL7.org"
}
]
}
],
"description": "This value set defines a set of codes that indicate the type of benefit in a product/plan.",
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"copyright": "Used by permission of HL7 International all rights reserved Creative Commons License",
"compose": {
"include": [
{
"system": "http://hl7.org/fhir/uv/vhdir/CodeSystem/payercharacteristics",
"concept": [
{
"code": "pcpov"
},
{
"code": "specialistov"
},
{
"code": "mlpov"
},
{
"code": "outpatient"
},
{
"code": "outpatstx"
},
{
"code": "hospserv"
},
{
"code": "routinedental"
},
{
"code": "infertilitytx"
},
{
"code": "ltnhc"
},
{
"code": "privatenurse"
},
{
"code": "routineeye"
},
{
"code": "ucservice"
},
{
"code": "homehealth"
},
{
"code": "erservice"
},
{
"code": "ambulance"
},
{
"code": "inpatienthospital"
},
{
"code": "inpatientprovider"
},
{
"code": "bariatricsurg"
},
{
"code": "cosmeticsurg"
},
{
"code": "skillednursing"
},
{
"code": "ppnatalcare"
},
{
"code": "maternitycare"
},
{
"code": "menthlthoutp"
},
{
"code": "menthlthinp"
},
{
"code": "sadoutp"
},
{
"code": "sadinp"
},
{
"code": "drggenric"
},
{
"code": "drgbrand"
},
{
"code": "drgnonpreferred"
},
{
"code": "drgspecialty"
},
{
"code": "rehaboutp"
},
{
"code": "servicehablitation"
},
{
"code": "chiro"
},
{
"code": "dme"
},
{
"code": "hearingaids"
},
{
"code": "imgctpetmri"
},
{
"code": "prev"
},
{
"code": "rtnpod"
},
{
"code": "acupuncture"
},
{
"code": "weightloss"
},
{
"code": "rtneyechld"
},
{
"code": "glasseschld"
},
{
"code": "rtndntlchld"
},
{
"code": "speachthpy"
},
{
"code": "rehaboccandpt"
},
{
"code": "wellbaby"
},
{
"code": "laboutp"
},
{
"code": "imagingdx"
},
{
"code": "dntlbaschld"
},
{
"code": "orthochld"
},
{
"code": "dntlmajchld"
},
{
"code": "dntlbasadlt"
},
{
"code": "orthodadlt"
},
{
"code": "dntlmajadlt"
},
{
"code": "abortion"
},
{
"code": "transplant"
},
{
"code": "accdntl"
},
{
"code": "dialysis"
},
{
"code": "testallrgy"
},
{
"code": "chemotherapy"
},
{
"code": "radiation"
},
{
"code": "edudiab"
},
{
"code": "prosthetic"
},
{
"code": "infusiontx"
},
{
"code": "tmjtx"
},
{
"code": "nutrition"
},
{
"code": "reconsurg"
}
]
}
]
}
}