FHIR IG analytics| Package | hl7.fhir.uv.xver-r5.r4 |
| Resource Type | ValueSet |
| Id | ValueSet-R5-v3-PayorRoleType-for-R4.json |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/uv/xver-r5.r4/0.1.0/ValueSet-R5-v3-PayorRoleType-for-R4.html |
| URL | http://hl7.org/fhir/uv/xver/ValueSet/R5-v3-PayorRoleType-for-R4 |
| Version | 0.1.0 |
| Status | active |
| Date | 2026-03-17T21:02:03.8104715+00:00 |
| Name | R5V3PayorRoleTypeForR4 |
| Title | Cross-version ValueSet R5.PayorRoleType for use in FHIR R4 |
| Realm | uv |
| Authority | hl7 |
| Description | This cross-version ValueSet represents content from `http://terminology.hl7.org/ValueSet/v3-PayorRoleType|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-PayorRoleType|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-PayorRoleType|2.0.0`, defined in FHIR R5 does not have any mapping to FHIR R4 |
No resources found
| CodeSystem | ||
| hl7.terminology#current | v3-RoleCode | RoleCode |
Note: links and images are rebased to the (stated) source
Generated Narrative: ValueSet R5-v3-PayorRoleType-for-R4
This value set expansion contains 4 concepts.
| System | Version | Code | Display | Definition |
http://terminology.hl7.org/CodeSystem/v3-RoleCode | 2.2.0 | ENROLBKR | Enrollment Broker | **Description:**A payor that is responsible for functions related to the enrollment of covered parties. |
http://terminology.hl7.org/CodeSystem/v3-RoleCode | 2.2.0 | TPA | Third party administrator | **Description:**Third party administrator (TPA) is a payor organization that processes health care claims without carrying insurance risk. Third party administrators are prominent players in the managed care industry and have the expertise and capability to administer all or a portion of the claims process. They are normally contracted by a health insurer or self-insuring companies to administer services, including claims administration, premium collection, enrollment and other administrative activities. Self-insured employers often contract with third party administrator to handle their insurance functions. Insurance companies oftentimes outsource the claims, utilization review or membership functions to a TPA. Sometimes TPAs only manage provider networks, only claims or only utilization review. While some third-party administrators may operate as units of insurance companies, they are often independent. However, hospitals or provider organizations desiring to set up their own health plans will often outsource certain responsibilities to TPAs. TPAs may perform one or several payor functions, specified by the PayorParticipationFunction value set, such as provider management, enrollment, utilization management, and fee for service claims adjudication management. |
http://terminology.hl7.org/CodeSystem/v3-RoleCode | 2.2.0 | UMO | Utilization management organization | **Description:**A payor that is responsible for review and case management of health services covered under a policy or program. |
http://terminology.hl7.org/CodeSystem/v3-RoleCode | 2.2.0 | _PayorRoleType | PayorRoleType | **Description:**PayorRoleType for a particular type of policy or program benefit package or plan where more detail about the coverage administration role of the Payor is required. The functions performed by a Payor qualified by a PayorRoleType may be specified by the PayorParticpationFunction value set. **Examples:**A Payor that is a TPA may administer a managed care plan without underwriting the risk. |
FHIR
FHIRsmith{
"resourceType": "ValueSet",
"id": "R5-v3-PayorRoleType-for-R4",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fhir"
},
{
"extension": [
{
"url": "packageId",
"valueId": "hl7.fhir.uv.xver-r5.r4"
},
{
"url": "version",
"valueString": "0.1.0"
},
{
"url": "uri",
"valueUri": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/package-source"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 0,
"_valueInteger": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical": "http://hl7.org/fhir/uv/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"
}
]
}
},
{
"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/xver/ImplementationGuide/hl7.fhir.uv.xver-r5.r4"
}
]
}
}
],
"url": "http://hl7.org/fhir/uv/xver/ValueSet/R5-v3-PayorRoleType-for-R4",
"version": "0.1.0",
"name": "R5V3PayorRoleTypeForR4",
"title": "Cross-version ValueSet R5.PayorRoleType for use in FHIR R4",
"status": "active",
"experimental": false,
"date": "2026-03-17T21:02:03.8104715+00:00",
"publisher": "FHIR Infrastructure",
"contact": [
{
"name": "FHIR Infrastructure",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fiwg"
}
]
}
],
"description": "This cross-version ValueSet represents content from `http://terminology.hl7.org/ValueSet/v3-PayorRoleType|2.0.0` for use in FHIR R4.",
"jurisdiction": [
{
"coding": [
{
"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"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-PayorRoleType|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-PayorRoleType|2.0.0`, defined in FHIR R5 does not have any mapping to FHIR R4",
"compose": {
"include": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"version": "2.2.0",
"concept": [
{
"code": "ENROLBKR",
"display": "Enrollment Broker"
},
{
"code": "TPA",
"display": "Third party administrator"
},
{
"code": "UMO",
"display": "Utilization management organization"
},
{
"code": "_PayorRoleType",
"display": "PayorRoleType"
}
]
}
]
},
"expansion": {
"timestamp": "2026-03-17T21:02:03.8104715+00:00",
"contains": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"version": "2.2.0",
"code": "ENROLBKR",
"display": "Enrollment Broker"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"version": "2.2.0",
"code": "TPA",
"display": "Third party administrator"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"version": "2.2.0",
"code": "UMO",
"display": "Utilization management organization"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"version": "2.2.0",
"code": "_PayorRoleType",
"display": "PayorRoleType"
}
]
}
}