InsuranceProductTypeCS

content: complete

title: Insurance Product Type

HL7 Financial Management Working Group

[System] url

[System] email

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/InsuranceProductTypeCS defines the following codes:

Code	Display	Definition

commppo 	Commercial PPO	Health insurance provided through a Preferred Provider Organization (PPO).

commhdhp 	Commercial HDHP	Health insurance provided through a High Deductible Health Plan (HDHP).

commpos 	Commercial POS	Health insurance provided through a Point-of-Service (POS) Plan.

commhmo 	Commercial HMO	Health insurance provided through a Health Maintenance Organization (HMO).

commepo 	Commercial EPO	Health insurance provided through a Exclusive Provider Organization(EPO).

medi 	Medicaid	Health insurance provided to eligible adults and children under the Federal Medicaid program

medihmo 	Medicaid HMO	Health insurance provided to eligible adults and children under the Federal Medicaid program through a Health Maintenance Organization (HMO).

mediadv 	Medicare Advantage	Health insurance provided by a private company that contracts with Medicare to provide all Medicare Part A and Part B benefits.

mediadvhmo 	Medicare Advantage HMO	Health insurance offered by a private company that contracts with Medicare to provide all Medicare Part A and Part B benefits through a Health Maintenance Organization (HMO).

media 	Medicare Part A	Health insurance provided under the Federal Medicare program covering inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

medib 	Medicare Part B	Health insurance provided under the Federal Medicfare program covering certain doctors' services, outpatient care, medical supplies, and preventive services.

medid 	Medicare Part D	Health insurance provided under the Federal Medicare program covering prescription drugs.

mediab 	Medicare A/B	Health insurance provided under the Federal Medicare program covering inpatient hospital stays, care in a skilled nursing facility, hospice care, some home health care, certain doctors' services, outpatient care, medical supplies, and preventive services.

qhp 	Qualified Health Plan	Health insurance provided through and certified by the Health Insurance Marketplace that provides essential health benefits (EHBs), follows established limits on cost sharing, and meets other requirements outlined within the application process.

ihs 	Indian Health Service	Health care program provided to United States American Indians and Alaska Natives.

fep 	Federal Employee Program	Health insurance provided to employees of the Federal government.

tri 	TRICARE	Health care program provided to uniformed service members, retirees, and their families around the world.

va 	Veterans Affairs Plan	Health care program provided to eligible veterans.

dent 	Dental Plan	Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the oral cavity.

denthmo 	Dental HMO	Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the oral cavity provided through a Health Maintenance Organization (HMO).

vis 	Vision Plan	Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the eyes.

vishmo 	Vision HMO	Health insurance provided to cover services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the eyes provided through a Health Maintenance Organization (HMO).


LanguageProficiencyCS

description: Codes for documenting spoken language proficiency based on the Interagency Language Roundtable scale of abilities to communicate in a language.

publisher: HL7 Financial Management Working Group

code: US

content: complete

resourceType: CodeSystem

title: Language Proficiency CS

status: active

HL7 Financial Management Working Group

[System] url

[System] email

status: generated

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/LanguageProficiencyCS defines the following codes:

Code	Display	Definition

00 	No proficiency	Unable to function in the spoken language.

10 	Elementary proficiency	Able to satisfy minimum courtesy requirements and maintain very simple face-to-face conversations on familiar topics. A native speaker must often use slowed speech, repetition, paraphrase, or a combination of these to be understood by this individual.

20 	Limited working proficiency	Able to satisfy routine social demands and limited work requirements.

30 	General professional proficiency	Able to speak the language with sufficient structural accuracy and vocabulary to participate effectively in most formal and informal conversations in practical, social and professional topics.

40 	Advanced professional proficiency	Able to use the language fluently and accurately on all levels normally pertinent to professional needs.

50 	Functional native proficiency	Speaking proficiency is functionally equivalent to that of a highly articulate well-educated native speaker and reflects the cultural standards of the country where the language is natively spoken.


OrgTypeCS

description: Categories of organizations based on criteria in provider directories.

content: complete

title: Organization Type

HL7 Financial Management Working Group

[System] url

[System] email

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/OrgTypeCS defines the following codes:

Code	Display	Definition

fac 	Facility	A physical healthcare facility.

prvgrp 	Provider Group	A healthcare provider entity

payer 	Payer	A healthcare payer.

atyprv 	Atypical Provider	Providers that do not provide healthcare

bus 	Non-Healthcare Business	An organization that does not meet the definitions of a Healthcare or Atypical Provider, and is not a payer or healthcare facility

ntwk 	Network	A healthcare provider insurance network


DeliveryMethodCS

description: Categories of healthcare service delivery methods.

content: complete

title: Delivery Methods

HL7 Financial Management Working Group

[System] url

[System] email

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/DeliveryMethodCS defines the following codes:

Code	Display	Definition

virtual 	Virtual	Delivery not requiring provider and patient to be physically co-located, such as tele-medicine

physical 	Physical	Traditional delivery requiring provider and patient to be physically co-located.


OrganizationAffiliationRoleCS

description: Codes For Organization Affiliation Role

content: complete

title: Organization Affiliation Role

HL7 Financial Management Working Group

[System] url

[System] email

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/OrganizationAffiliationRoleCS defines the following codes:

Code	Display	Definition

behavioral 	Outpatient Behavioral Health Provider	Provider of services related to the promotion of mental health, resilience and wellbeing; the treatment of mental and substance use disorders; and the support of those who experience and/or are in recovery from these conditions, along with their families and communities.

bt 	Member Of	Has a relationship of participation with.  This does NOT represent a member of an insurance plan, but other types of membership such as membership of a hospital in an HIE

dme 	DME/Medical Supplier	Supplier of health care consumables or equipments supplied to patients.

group 	Medical Group	A group of people, e.g. a group of Physicians, who render health care services.

home 	Home Health Provider	Provider of health care services delivered to patients within their residence rather than a clinical setting; usually provided by nurses, home health aides, and other professionals on a regularly scheduled visit.

hospital 	Hospital	An inpatient facility, other than long-term care, providng patient treatment with specialzed medical and nursing staff and medical equipment.

laboratory 	Laboratory	Pathology and laboratory testing on clinical specimenst to obtain informaion about the health of a paeint to aid in diagnosis, treatment and prevention of disease.

other 	Other	A provider of heatlh care services not otherwise listed in this value set.

outpatient 	Clinic or Outpatient Facility	An outpatient facility providing patient services, e.g. medical procedures, surgeries, etc.

pharmacy 	Pharmacy	An entity which provider services related to the storage, compounding, dispensing and sale of drugs.

transport 	Transporation Provider	A provider which transports patients to or from a medical facility, e.g., ambulance.

urgent 	Urgent Care Center	A center in which unscheduled health care services are provided for point-in-time evaluation or treatment of a non-life-threatening medical condition.

hospice 	Hospice	Hospice

nurseCustodial 	Nursing and Custodial Care Facility	Nursing and Custodial Care Facility

residential 	Residential Treatment Facility	Residential Treatment Facility

respite 	Respite Care Facility	Respite Care Facility

retail 	Retail Health Center	Retail Health Center


VirtualModalitiesCS

description: Categories of virtual service delivery modalities.

content: complete

title: Virtual Modalities

HL7 Financial Management Working Group

[System] url

[System] email

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/VirtualModalitiesCS defines the following codes:

Code	Display	Definition

phone 	phone	Voice Telephone

video 	video chat	Video Chat

tdd 	TDD	Telecommunications Device for the Deaf

sms 	SMS	SMS Text Messaging

app 	App	Mobile Application

web 	Website	Website accessed through browser


AccessibilityCS

description: General categories of accommodations available.

content: complete

title: Accessibility CS

HL7 Financial Management Working Group

[System] url

[System] email

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/AccessibilityCS defines the following codes:

Code	Display	Definition

cultcomp 	Cultural competence	Provides services that meet the social, cultural, and linguistic needs of persons.

handiaccess 	handicap accessible	Provides access to persons with disabilities.

adacomp 	ADA compliant	Provides access which complies with the Americans with Disabilities Act and/or amendments.

pubtrans 	public transit options	Provides access using public transportation modes.

anssrvc 	answering service	Provides capability to communicate when intended recipient is not immediately available.

cognitive 	cognitive	Provides services for cognitively impaired persons.

mobility 	mobility	Provides services for mobility impaired persons.


ProviderRoleCS

description: A capability that an individual, group, or organization is acknowledged to have in a payer network.

content: complete

title: Provider Role Codes

HL7 Financial Management Working Group

[System] url

[System] email

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/ProviderRoleCS defines the following codes:

Code	Display	Definition

ap 	Admitting Privileges	Practitioner has admitting privileges at hospital (organization)

apn 	Advanced Practice Nursing Providers	Advanced Practice Nursing Providers

at 	Athletic Trainer	Athletic Trainer

au 	Audiologist	Audiologist

bh 	Behavioral Health & Social Service Providers	Behavioral Health & Social Service Providers

ba 	Board Certified Behavior Analyst	Board Certified Behavior Analyst

bt 	Member Of	Has a relationship of participation with.  This does NOT represent a member of an insurance plan, but other types of membership such as membership of physician in the AMA

cnw 	Certified Nurse Midwife	Certified Nurse Midwife

crnp 	Certified Registered Nurse Practitioner	Certified Registered Nurse Practitioner

ch 	Chiropractor	Chiropractor

cs 	Christian Science Practitioner	Christian Science Practitioner

co 	Counselor	Counselor

dp 	Dental Provider	Dental Provider

de 	Dentist	Dentist

drr 	Developmental, Rehabilitative and Restorative Service Providers	Developmental, Rehabilitative and Restorative Service Providers

dn 	Dietary and Nutritional Service Provider	Dietary and Nutritional Service Provider

om 	Doctor of Oriental Medicine	Doctor of Oriental Medicine

em 	Emergency Medical Service Provider	Emergency Medical Service Provider

ho 	Homeopath	Homeopath

lpn 	Licensed Practical Nurse	Licensed Practical Nurse

mt 	Marriage/Family Therapist	Marriage/Family Therapist

ma 	Massage Therapist	Massage Therapist

nh 	Naprapath	Naprapath

na 	Naturopath	Naturopath

nu 	Nursing Service Related Providers	Nursing Service Related Providers

ot 	Occupational Therapist	Occupational Therapist

op 	Optician	Optician

oo 	Optometrist	Optometrist

os 	Other Service Provider	Other Service Provider

rx 	Pharmacy Service Providers	Pharmacy Service Providers

pt 	Physical Therapist	Physical Therapist

ph 	Physician	Physician

pa 	Physician Assistant	Physician Assistant

po 	Podiatrist	Podiatrist

py 	Psychologist	Psychologist

rn 	Registered Nurse	Registered Nurse

rt 	Respiratory Therapist	Respiratory Therapist

sw 	Social Worker	Social Worker

sp 	Speech Language Pathologist	Speech Language Pathologist

sh 	Speech, Language and Hearing Service Providers	Speech, Language and Hearing Service Providers

te 	Technologists, Technicians and Other Technical Service Providers	Technologists, Technicians and Other Technical Service Providers


EndpointPayloadTypeCS

description: Endpoint Payload Types are constrained to NA (Not Applicable) as part of this IG

content: complete

title: Endpoint Payload Types

HL7 Financial Management Working Group

[System] url

[System] email

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/EndpointPayloadTypeCS defines the following codes:

Code	Display	Definition

NA 	Not Applicable	Not Applicable


HealthcareServiceCategoryCS

description: Broad categories of healthcare services being performed or delivered

content: complete

title: Healthcare Service Category

HL7 Financial Management Working Group

[System] url

[System] email

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/HealthcareServiceCategoryCS defines the following codes:

Code	Display	Definition

behav 	Behavioral Health	Services related to the promotion of mental health, resilience and wellbeing; the treatment of mental and substance use disorders; and the support of those who experience and/or are in recovery from these conditions, along with their families and communities.

dent 	Dental	Services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the mouth.

dme 	DME/Medical Supplies	Health care consumables or equipments supplied to patients

emerg 	Emergency care	Health care services rendered within a designated emergency care facility, for point-in-time evaluation and/or treatment any medical condition such that a prudent layperson possessing an average knowledge of medicine and health, believes that immediate unscheduled medical care is required.

group 	Medical Group	Health care services rendered by a group of people, e.g. a group of Physicians.

home 	Home Health	Health care services delivered to patients within their residence rather than a clinical setting; usually provided by nurses, home health aides, and other professionals on a regularly scheduled visit.

hosp 	Hospital	Health care services rendered within a hospital or other inpatient setting providng patient treatment with specialzed medical and nursing staff and medical equipment.

lab 	Laboratory	Pathology and laboratory testing on clinical specimenst to obtain informaion about the health of a paeint to aid in diagnosis, treatment and prevention of disease.

other 	Other	Other

outpat 	Clinic or Outpatient Facility	Health care services rendered in an outpatient facility, e.g. medical procedures, surgeries, etc.

prov 	Medical Provider	Health care services rendered by a person, e.g. Physician.

pharm 	Pharmacy	Services related to the storage, compounding, dispensing and sale of drugs.

trans 	Transportation	Services which transport patients to or from a medical facility, e.g., ambulance.

urg 	Urgent Care	Unscheduled health care services which provide for point-in-time evaluation or treatment of a non-life-threatening medical condition.

vis 	Vision	Services related to the study, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the eyes.


QualificationStatusCS

description: The state indicating if a qualification is currently valid.

content: complete

title: Qualification Status

HL7 Financial Management Working Group

[System] url

[System] email

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/QualificationStatusCS defines the following codes:

Code	Display	Definition

active 	active	The credential may be considered valid for use.

inactive 	inactive	The credential may not be considered valid for use.

issiner 	issued in error	The credential was mistakenly assigned and should not be considered valid for use.

revoked 	revoked	The credential was revoked by the issuing organization and should not be considered valid for use.

pending 	pending	The credential has not been officially assigned. It may or may not be considered valid for use.

unknown 	unknown	The status of this credential is unknown. It may or may not be considered valid for use.


InsurancePlanTypeCS

description: Categories of cost-sharing used by plans

content: complete

title: Insurance Plan Type

HL7 Financial Management Working Group

[System] url

[System] email

div:
This code system http://hl7.org/fhir/us/davinci-pdex-plan-net/CodeSystem/InsurancePlanTypeCS defines the following codes:

Code	Display	Definition

platinum 	Platinum-QHP	Plan with highest monthly premium and lowest costs when you need care	A Qualified Health Plan with the highest monthly premiums and smallest out-of-pocket costs for the member in comparison to other metal-category plans

gold 	Gold-QHP	Plan with high monthly premium and low costs when you need care	A Qualified Health Plan with the higher monthly premiums and smaller out-of-pocket costs for the member in comparison to other metal-category plans

silver 	Silver-QHP	Plan with moderate monthly premium and moderate costs when you need care	A Qualified Health Plan with the lower monthly premiums and larger out-of-pocket costs for the member in comparison to other metal-category plans

bronze 	Bronze-QHP	Plan with lowest monthly premium and highest costs when you need care	A Qualified Health Plan with the lowest monthly premiums and largest out-of-pocket costs for the member in comparison to other metal-category plans

catastrophic 	Catastrophic-QHP	A plan with low monthly premiums and very high deductibles and are available only to those under 30 or with certain special exemptions.

lowdeductible 	Low Deductible	A plan that requires the insured to pay out of pocket a smaller proportion of incurred health care costs than a traditional insurance plan.

highdeductible 	High Deductible	A plan that requires the insured to pay out of pocket a larger proportion of incurred health care costs than a traditional insurance plan.

catastrophicplan 	Catastrophic Plan	A plan that requires the insured to pay out of pocket a much larger proportion of incurred health care costs than a traditional insurance plan.