FHIR IG analytics| Package | hl7.fhir.uv.xver-r5.r4b |
| Resource Type | ValueSet |
| Id | ValueSet-R5-v3-PayorParticipationFunction-for-R4B.json |
| FHIR Version | R4B |
| Source | http://hl7.org/fhir/uv/xver-r5.r4b/0.0.1-snapshot-2/ValueSet-R5-v3-PayorParticipationFunction-for-R4B.html |
| URL | http://hl7.org/fhir/5.0/ValueSet/R5-v3-PayorParticipationFunction-for-R4B |
| Version | 0.0.1-snapshot-2 |
| Status | active |
| Date | 2025-09-01T22:37:05.284192+10:00 |
| Name | R5_v3_PayorParticipationFunction_for_R4B |
| Title | Cross-version VS for R5.PayorParticipationFunction for use in FHIR R4B |
| Realm | uv |
| Authority | hl7 |
| Description | This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-PayorParticipationFunction|2.0.0 for use in FHIR R4B. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4B. |
No resources found
| CodeSystem | |
| v3-ParticipationFunction | ParticipationFunction |
Note: links and images are rebased to the (stated) source
Generated Narrative: ValueSet R5-v3-PayorParticipationFunction-for-R4B
This value set expansion contains 6 concepts.
| Code | System | Display | Definition |
| CLMADJ | http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction | claims adjudication | Definition: Manages all operations required to adjudicate fee for service claims or managed care encounter reports. |
| ENROLL | http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction | enrollment broker | Definition: Managing the enrollment of covered parties. |
| FFSMGT | http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction | ffs 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. |
| MCMGT | http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction | managed 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. |
| PROVMGT | http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction | provider management | Definition: Managing provider contracting, provider services, credentialing, profiling, performance measures, and ensuring network adequacy. |
| UMGT | http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction | utilization 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. |
FHIR
FHIRsmith{
"resourceType": "ValueSet",
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"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
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"_valueInteger": {
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],
"url": "http://hl7.org/fhir/5.0/ValueSet/R5-v3-PayorParticipationFunction-for-R4B",
"version": "0.0.1-snapshot-2",
"name": "R5_v3_PayorParticipationFunction_for_R4B",
"title": "Cross-version VS for R5.PayorParticipationFunction for use in FHIR R4B",
"status": "active",
"experimental": false,
"date": "2025-09-01T22:37:05.284192+10:00",
"publisher": "FHIR Infrastructure",
"contact": [
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"telecom": [
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"description": "This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-PayorParticipationFunction|2.0.0 for use in FHIR R4B. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4B.",
"jurisdiction": [
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"compose": {
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{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction",
"version": "2.1.0",
"concept": [
{
"code": "CLMADJ",
"display": "claims adjudication"
},
{
"code": "ENROLL",
"display": "enrollment broker"
},
{
"code": "FFSMGT",
"display": "ffs management"
},
{
"code": "MCMGT",
"display": "managed care management"
},
{
"code": "PROVMGT",
"display": "provider management"
},
{
"code": "UMGT",
"display": "utilization management"
}
]
}
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},
"expansion": {
"timestamp": "2025-09-01T22:37:05.284193+10:00",
"contains": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction",
"version": "2.1.0",
"code": "CLMADJ",
"display": "claims adjudication"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction",
"version": "2.1.0",
"code": "ENROLL",
"display": "enrollment broker"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction",
"version": "2.1.0",
"code": "FFSMGT",
"display": "ffs management"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction",
"version": "2.1.0",
"code": "MCMGT",
"display": "managed care management"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction",
"version": "2.1.0",
"code": "PROVMGT",
"display": "provider management"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction",
"version": "2.1.0",
"code": "UMGT",
"display": "utilization management"
}
]
}
}