FHIR IG analytics| Package | hl7.fhir.uv.xver-r5.r4b |
| Resource Type | ValueSet |
| Id | ValueSet-R5-v3-PayorRoleType-for-R4B.json |
| FHIR Version | R4B |
| Source | http://hl7.org/fhir/uv/xver-r5.r4b/0.0.1-snapshot-2/ValueSet-R5-v3-PayorRoleType-for-R4B.html |
| URL | http://hl7.org/fhir/5.0/ValueSet/R5-v3-PayorRoleType-for-R4B |
| Version | 0.0.1-snapshot-2 |
| Status | active |
| Date | 2025-09-01T22:37:05.284258+10:00 |
| Name | R5_v3_PayorRoleType_for_R4B |
| Title | Cross-version VS for R5.PayorRoleType for use in FHIR R4B |
| Realm | uv |
| Authority | hl7 |
| Description | This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-PayorRoleType|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-RoleCode | RoleCode |
Note: links and images are rebased to the (stated) source
Generated Narrative: ValueSet R5-v3-PayorRoleType-for-R4B
This value set expansion contains 3 concepts.
| Code | System | Display | Definition |
| ENROLBKR | http://terminology.hl7.org/CodeSystem/v3-RoleCode | Enrollment Broker | **Description:**A payor that is responsible for functions related to the enrollment of covered parties. |
| TPA | http://terminology.hl7.org/CodeSystem/v3-RoleCode | 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. |
| UMO | http://terminology.hl7.org/CodeSystem/v3-RoleCode | Utilization management organization | **Description:**A payor that is responsible for review and case management of health services covered under a policy or program. |
FHIR
FHIRsmith{
"resourceType": "ValueSet",
"id": "R5-v3-PayorRoleType-for-R4B",
"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.r4b"
},
{
"url": "version",
"valueString": "0.0.1-snapshot-2"
}
],
"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/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4b"
}
]
}
},
{
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"valueCode": "trial-use",
"_valueCode": {
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"valueCanonical": "http://hl7.org/fhir/5.0/ImplementationGuide/hl7.fhir.uv.xver-r5.r4b"
}
]
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}
],
"url": "http://hl7.org/fhir/5.0/ValueSet/R5-v3-PayorRoleType-for-R4B",
"version": "0.0.1-snapshot-2",
"name": "R5_v3_PayorRoleType_for_R4B",
"title": "Cross-version VS for R5.PayorRoleType for use in FHIR R4B",
"status": "active",
"experimental": false,
"date": "2025-09-01T22:37:05.284258+10:00",
"publisher": "FHIR Infrastructure",
"contact": [
{
"name": "FHIR Infrastructure",
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fiwg"
}
]
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],
"description": "This cross-version ValueSet represents concepts from http://terminology.hl7.org/ValueSet/v3-PayorRoleType|2.0.0 for use in FHIR R4B. Concepts not present here have direct `equivalent` mappings crossing all versions from R5 to R4B.",
"jurisdiction": [
{
"coding": [
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"system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code": "001",
"display": "World"
}
]
}
],
"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"
}
]
}
]
},
"expansion": {
"timestamp": "2025-09-01T22:37:05.284259+10:00",
"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"
}
]
}
}