FHIR IG analytics| Package | hl7.fhir.uv.xver-r5.r4 |
| Resource Type | ValueSet |
| Id | ValueSet-R5-v3-ActCoverageReason-for-R4.json |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/uv/xver-r5.r4/0.1.0/ValueSet-R5-v3-ActCoverageReason-for-R4.html |
| URL | http://hl7.org/fhir/uv/xver/ValueSet/R5-v3-ActCoverageReason-for-R4 |
| Version | 0.1.0 |
| Status | active |
| Date | 2026-03-17T21:02:03.8104715+00:00 |
| Name | R5V3ActCoverageReasonForR4 |
| Title | Cross-version ValueSet R5.ActCoverageReason for use in FHIR R4 |
| Realm | uv |
| Authority | hl7 |
| Description | This cross-version ValueSet represents content from `http://terminology.hl7.org/ValueSet/v3-ActCoverageReason|2.0.0` for use in FHIR R4. |
| Purpose | This value set is part of the cross-version definitions generated to enable use of the value set `http://terminology.hl7.org/ValueSet/v3-ActCoverageReason|2.0.0` as defined in FHIR R5 in FHIR R4. The source value set is bound to the following FHIR R5 elements: * Note that all concepts are included in this cross-version definition because no concepts have compatible representations Following are the generation technical comments: FHIR ValueSet `http://terminology.hl7.org/ValueSet/v3-ActCoverageReason|2.0.0`, defined in FHIR R5 does not have any mapping to FHIR R4 |
No resources found
| CodeSystem | ||
| hl7.terminology#current | v3-ActReason | ActReason |
Note: links and images are rebased to the (stated) source
Generated Narrative: ValueSet R5-v3-ActCoverageReason-for-R4
This value set expansion contains 23 concepts.
| System | Version | Code | Display | Definition |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | AGE | age eligibility | A person becomes eligible for a program based on age. Example: In the U.S., a person who is 65 years of age or older is eligible for Medicare. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | COVSUS | coverage suspended | When a client has no contact with the health system for an extended period, coverage is suspended. Client will be reinstated to original start date upon proof of identification, residency etc. Example: Coverage may be suspended during a strike situation, when employer benefits for employees are not covered (i.e. not in effect). |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | CRIME | crime victim | A person becomes eligible for insurance or a program because of crime related health condition or injury. Example: A person is a claimant under the U.S. Crime Victims Compensation program. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | DECSD | deceased | Client deceased. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | DIS | disability | A person becomes a claimant under a disability income insurance policy or a disability rehabilitation program because of a health condition or injury which limits the person's ability to earn an income or function without institutionalization. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | EMPLOY | employment benefit | A person becomes eligible for insurance provided as an employment benefit based on employment status. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | FINAN | financial eligibility | A person becomes eligible for a program based on financial criteria. Example: A person whose family income is below a financial threshold for eligibility for Medicaid or SCHIP. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | HEALTH | health status | A person becomes eligible for a program because of a qualifying health condition or injury. Examples: A person is determined to have a qualifying health conditions include pregnancy, HIV/AIDs, tuberculosis, end stage renal disease, breast or cervical cancer, or other condition requiring specialized health services, hospice, institutional or community based care provided under a program |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | MULTI | multiple criteria eligibility | A person becomes eligible for a program based on more than one criterion. Examples: In the U.S., a child whose familiy income meets Medicaid financial thresholds and whose age is less than 18 is eligible for the Early and Periodic Screening, Diagnostic, and Treatment program (EPSDT). A person whose family income meets Medicaid financial thresholds and whose age is 65 years or older is eligible for Medicaid and Medicare, and are referred to as dual eligibles. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | PNC | property and casualty condition | A person becomes a claimant under a property and casualty insurance policy because of a related health condition or injury resulting from a circumstance covered under the terms of the policy. Example: A person is a claimant under a homeowners insurance policy because of an injury sustained on the policyholderaTMs premises. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | REGERR | registered in error | Client was registered in error. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | STATUTORY | statutory eligibility | A person becomes eligible for a program based on statutory criteria. Examples: A person is a member of an indigenous group, a veteran of military service, or in the U.S., a recipient of adoption assistance and foster care under Title IV-E of the Social Security. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | VEHIC | motor vehicle accident victim | A person becomes a claimant under a motor vehicle accident insurance because of a motor vehicle accident related health condition or injury. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | WORK | work related | A person becomes eligible for insurance or a program because of a work related health condition or injury. Example: A person is a claimant under the U.S. Black Lung Program. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | _ActCoverageProviderReason | ActCoverageProviderReason | **Description:**Identifies the reason or rationale for coverage of a service or product based on characteristics of the provider, e.g., contractual relationship to payor, such as in or out-of-network; relationship of the covered party to the provider. **Example:**In closed managed care plan, a covered party is assigned a primary care provider who provides primary care services and authorizes referrals and ancillary and non-primary care services. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | _ActCoverageReason | ActCoverageReason | **Description:**Codes used to specify reasons or criteria relating to coverage provided under a policy or program. May be used to convey reasons pertaining to coverage contractual provisions, including criteria for eligibility, coverage limitations, coverage maximums, or financial participation required of covered parties. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | _ActCoverageServiceReason | ActCoverageServiceReason | **Description:**Identifies the reason or rationale for coverage of a service or product based on clinical efficacy criteria or practices prescribed by the payor. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | _ActIneligibilityReason | ActIneligibilityReason | Identifies the reason or rational for why a person is not eligibile for benefits under an insurance policy. Examples are client deceased & adopted client has been given a new policy identifier. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | _CoverageEligibilityReason | CoverageEligibilityReason | Definition: Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam. Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | _CoverageExclusionReason | CoverageExclusionReason | Definition: Identifies the reason or rationale for coverage of a service or product based on coverage exclusions related to the risk of adverse selection by covered parties. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | _CoverageFinancialParticipationReason | CoverageFinancialParticipationReason | **Description:**Identifies the reason or rationale for coverage of a service or product based on financial participation responsibilities of the covered party. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | _CoverageLimitationReason | CoverageLimitationReason | **Description:**Identifies the reason or rationale for limitations on the coverage of a service or product based on coverage contract provisions. **Example:**The maximum cost per unit; or the maximum number of units per period, which is typically the policy or program effective time. |
http://terminology.hl7.org/CodeSystem/v3-ActReason | 2.1.0 | _EligibilityActReasonCode | EligibilityActReasonCode | Identifies the reason or rational for why a person is eligibile for benefits under an insurance policy or progam. Examples: A person is a claimant under an automobile insurance policy are client deceased & adopted client has been given a new policy identifier. A new employee is eligible for health insurance as an employment benefit. A person meets a government program eligibility criteria for financial, age or health status. |
FHIR
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"url": "http://hl7.org/fhir/uv/xver/ValueSet/R5-v3-ActCoverageReason-for-R4",
"version": "0.1.0",
"name": "R5V3ActCoverageReasonForR4",
"title": "Cross-version ValueSet R5.ActCoverageReason for use in FHIR R4",
"status": "active",
"experimental": false,
"date": "2026-03-17T21:02:03.8104715+00:00",
"publisher": "FHIR Infrastructure",
"contact": [
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"description": "This cross-version ValueSet represents content from `http://terminology.hl7.org/ValueSet/v3-ActCoverageReason|2.0.0` for use in FHIR R4.",
"jurisdiction": [
{
"coding": [
{
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"purpose": "This value set is part of the cross-version definitions generated to enable use of the\r\nvalue set `http://terminology.hl7.org/ValueSet/v3-ActCoverageReason|2.0.0` as defined in FHIR R5\r\nin FHIR R4.\r\n\r\nThe source value set is bound to the following FHIR R5 elements:\r\n* \r\n\r\nNote that all concepts are included in this cross-version definition because no concepts have compatible representations\r\n\r\nFollowing are the generation technical comments:\r\n\nFHIR ValueSet `http://terminology.hl7.org/ValueSet/v3-ActCoverageReason|2.0.0`, defined in FHIR R5 does not have any mapping to FHIR R4",
"compose": {
"include": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"concept": [
{
"code": "AGE",
"display": "age eligibility"
},
{
"code": "COVSUS",
"display": "coverage suspended"
},
{
"code": "CRIME",
"display": "crime victim"
},
{
"code": "DECSD",
"display": "deceased"
},
{
"code": "DIS",
"display": "disability"
},
{
"code": "EMPLOY",
"display": "employment benefit"
},
{
"code": "FINAN",
"display": "financial eligibility"
},
{
"code": "HEALTH",
"display": "health status"
},
{
"code": "MULTI",
"display": "multiple criteria eligibility"
},
{
"code": "PNC",
"display": "property and casualty condition"
},
{
"code": "REGERR",
"display": "registered in error"
},
{
"code": "STATUTORY",
"display": "statutory eligibility"
},
{
"code": "VEHIC",
"display": "motor vehicle accident victim"
},
{
"code": "WORK",
"display": "work related"
},
{
"code": "_ActCoverageProviderReason",
"display": "ActCoverageProviderReason"
},
{
"code": "_ActCoverageReason",
"display": "ActCoverageReason"
},
{
"code": "_ActCoverageServiceReason",
"display": "ActCoverageServiceReason"
},
{
"code": "_ActIneligibilityReason",
"display": "ActIneligibilityReason"
},
{
"code": "_CoverageEligibilityReason",
"display": "CoverageEligibilityReason"
},
{
"code": "_CoverageExclusionReason",
"display": "CoverageExclusionReason"
},
{
"code": "_CoverageFinancialParticipationReason",
"display": "CoverageFinancialParticipationReason"
},
{
"code": "_CoverageLimitationReason",
"display": "CoverageLimitationReason"
},
{
"code": "_EligibilityActReasonCode",
"display": "EligibilityActReasonCode"
}
]
}
]
},
"expansion": {
"timestamp": "2026-03-17T21:02:03.8104715+00:00",
"contains": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "AGE",
"display": "age eligibility"
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{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "COVSUS",
"display": "coverage suspended"
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{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
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{
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{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
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"code": "DIS",
"display": "disability"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "EMPLOY",
"display": "employment benefit"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "FINAN",
"display": "financial eligibility"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "HEALTH",
"display": "health status"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "MULTI",
"display": "multiple criteria eligibility"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "PNC",
"display": "property and casualty condition"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
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"code": "REGERR",
"display": "registered in error"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "STATUTORY",
"display": "statutory eligibility"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "VEHIC",
"display": "motor vehicle accident victim"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "WORK",
"display": "work related"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "_ActCoverageProviderReason",
"display": "ActCoverageProviderReason"
},
{
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"version": "2.1.0",
"code": "_ActCoverageReason",
"display": "ActCoverageReason"
},
{
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"version": "2.1.0",
"code": "_ActCoverageServiceReason",
"display": "ActCoverageServiceReason"
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{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "_ActIneligibilityReason",
"display": "ActIneligibilityReason"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "_CoverageEligibilityReason",
"display": "CoverageEligibilityReason"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "_CoverageExclusionReason",
"display": "CoverageExclusionReason"
},
{
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"version": "2.1.0",
"code": "_CoverageFinancialParticipationReason",
"display": "CoverageFinancialParticipationReason"
},
{
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"version": "2.1.0",
"code": "_CoverageLimitationReason",
"display": "CoverageLimitationReason"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"version": "2.1.0",
"code": "_EligibilityActReasonCode",
"display": "EligibilityActReasonCode"
}
]
}
}