Terminology

CodeSystem:ContractResourceDefinitionTypeCodes

This value set contract specific codes for status.
CodeDisplayDefinition
tempTemporary ValueTo be completed

CodeSystem:ExampleVisionPrescriptionProductCodes

This value set includes a smattering of Prescription Product codes.
CodeDisplayDefinition
lensLensA lens to be fitted to a frame to comprise a pair of glasses.
contactContact LensA lens to be fitted for wearing directly on an eye.

CodeSystem:VisionEyes

A coded concept listing the eye codes.
CodeDisplayDefinition
rightRight EyeRight Eye.
leftLeft EyeLeft Eye.

CodeSystem:ContractResourceDefinitionSubtypeCodes

This value set contract specific codes for status.
CodeDisplayDefinition
tempTemporary ValueTo be completed

CodeSystem:ContractActionCodes

This value set includes sample Contract Action codes.
CodeDisplayDefinition
action-aAction ADefinition for Action A
action-bAction BDefinition for Action B

CodeSystem:ContractResourcePublicationStatusCodes

This value set contract specific codes for status.
CodeDisplayDefinition
amendedAmendedContract is augmented with additional information to correct errors in a predecessor or to updated values in a predecessor. Usage: Contract altered within effective time. Precedence Order = 9. Comparable FHIR and v.3 status codes: revised; replaced.
appendedAppendedContract is augmented with additional information that was missing from a predecessor Contract. Usage: Contract altered within effective time. Precedence Order = 9. Comparable FHIR and v.3 status codes: updated, replaced.
cancelledCancelledContract is terminated due to failure of the Grantor and/or the Grantee to fulfil one or more contract provisions. Usage: Abnormal contract termination. Precedence Order = 10. Comparable FHIR and v.3 status codes: stopped; failed; aborted.
disputedDisputedContract is pended to rectify failure of the Grantor or the Grantee to fulfil contract provision(s). E.g., Grantee complaint about Grantor's failure to comply with contract provisions. Usage: Contract pended. Precedence Order = 7. Comparable FHIR and v.3 status codes: on hold; pended; suspended.
entered-in-errorEntered in ErrorContract was created in error. No Precedence Order. Status may be applied to a Contract with any status.
executableExecutableContract execution pending; may be executed when either the Grantor or the Grantee accepts the contract provisions by signing. I.e., where either the Grantor or the Grantee has signed, but not both. E.g., when an insurance applicant signs the insurers application, which references the policy. Usage: Optional first step of contract execution activity. May be skipped and contracting activity moves directly to executed state. Precedence Order = 3. Comparable FHIR and v.3 status codes: draft; preliminary; planned; intended; active.
executedExecutedContract is activated for period stipulated when both the Grantor and Grantee have signed it. Usage: Required state for normal completion of contracting activity. Precedence Order = 6. Comparable FHIR and v.3 status codes: accepted; completed.
negotiableNegotiableContract execution is suspended while either or both the Grantor and Grantee propose and consider new or revised contract provisions. I.e., where the party which has not signed proposes changes to the terms. E .g., a life insurer declines to agree to the signed application because the life insurer has evidence that the applicant, who asserted to being younger or a non-smoker to get a lower premium rate - but offers instead to agree to a higher premium based on the applicants actual age or smoking status. Usage: Optional contract activity between executable and executed state. Precedence Order = 4. Comparable FHIR and v.3 status codes: in progress; review; held.
offeredOfferedContract is a proposal by either the Grantor or the Grantee. Aka - A Contract hard copy or electronic 'template', 'form' or 'application'. E.g., health insurance application; consent directive form. Usage: Beginning of contract negotiation, which may have been completed as a precondition because used for 0..* contracts. Precedence Order = 2. Comparable FHIR and v.3 status codes: requested; new.
policyPolicyContract template is available as the basis for an application or offer by the Grantor or Grantee. E.g., health insurance policy; consent directive policy. Usage: Required initial contract activity, which may have been completed as a precondition because used for 0..* contracts. Precedence Order = 1. Comparable FHIR and v.3 status codes: proposed; intended.
rejectedRejected Execution of the Contract is not completed because either or both the Grantor and Grantee decline to accept some or all of the contract provisions. Usage: Optional contract activity between executable and abnormal termination. Precedence Order = 5. Comparable FHIR and v.3 status codes: stopped; cancelled.
renewedRenewedBeginning of a successor Contract at the termination of predecessor Contract lifecycle. Usage: Follows termination of a preceding Contract that has reached its expiry date. Precedence Order = 13. Comparable FHIR and v.3 status codes: superseded.
revokedRevokedA Contract that is rescinded. May be required prior to replacing with an updated Contract. Comparable FHIR and v.3 status codes: nullified.
resolvedResolvedContract is reactivated after being pended because of faulty execution. *E.g., competency of the signer(s), or where the policy is substantially different from and did not accompany the application/form so that the applicant could not compare them. Aka - ''reactivated''. Usage: Optional stage where a pended contract is reactivated. Precedence Order = 8. Comparable FHIR and v.3 status codes: reactivated.
terminatedTerminatedContract reaches its expiry date. It might or might not be renewed or renegotiated. Usage: Normal end of contract period. Precedence Order = 12. Comparable FHIR and v.3 status codes: Obsoleted.

CodeSystem:ExampleProcedureTypeCodes

This value set includes example Procedure Type codes.
CodeDisplayDefinition
primaryPrimary procedureThe first procedure in a series required to produce and overall patient outcome.
secondarySecondary procedureThe second procedure in a series required to produce and overall patient outcome.

CodeSystem:EligibilityResponsePurpose

A code specifying the types of information being requested.
CodeDisplayDefinition
auth-requirementsCoverage auth-requirementsThe prior authorization requirements for the listed, or discovered if specified, converages for the categories of service and/or specifed biling codes are requested.
benefitsCoverage benefitsThe plan benefits and optionally benefits consumed for the listed, or discovered if specified, converages are requested.
discoveryCoverage DiscoveryThe insurer is requested to report on any coverages which they are aware of in addition to any specifed.
validationCoverage ValidationA check that the specified coverages are in-force is requested.

CodeSystem:ExampleDiagnosisOnAdmissionCodes

This value set includes example Diagnosis on Admission codes.
CodeDisplayDefinition
yYesDiagnosis was present at time of inpatient admission.
nNoDiagnosis was not present at time of inpatient admission.
uUnknownDocumentation insufficient to determine if condition was present at the time of inpatient admission.
wUndeterminedClinically undetermined. Provider unable to clinically determine whether the condition was present at the time of inpatient admission.

CodeSystem:PaymentAdjustmentReasonCodes

This value set includes smattering of Payment Adjustment Reason codes.
CodeDisplayDefinition
a001Prior Payment ReversalPrior Payment Reversal
a002Prior OverpaymentPrior Overpayment

CodeSystem:PaymentStatusCodes

This value set includes a sample set of Payment Status codes.
CodeDisplayDefinition
paidPaidThe payment has been sent physically or electronically.
clearedClearedThe payment has been received by the payee.

CodeSystem:ContractResourceAssetScopeCodes

This value set contract specific codes for asset scope.
CodeDisplayDefinition
thingThingTo be completed

CodeSystem:ContractResourceAssetSub-TypeCodes

This value set contract specific codes for asset subtype.
CodeDisplayDefinition
participationParticipationTo be completed

CodeSystem:InvoiceStatus

Codes identifying the lifecycle stage of an Invoice.
CodeDisplayDefinition
draftdraftthe invoice has been prepared but not yet finalized.
issuedissuedthe invoice has been finalized and sent to the recipient.
balancedbalancedthe invoice has been balaced / completely paid.
cancelledcancelledthe invoice was cancelled.
entered-in-errorentered in errorthe invoice was determined as entered in error before it was issued.

CodeSystem:ContractResourceAssetContextCodes

This value set contract specific codes for asset context.
CodeDisplayDefinition
custodianCustodianTo be completed

CodeSystem:ContractTermTypeCodes

This value set includes sample Contract Term Type codes.
CodeDisplayDefinition
statutoryStatutoryBased on specialized statutes that deal with particular subjects.
subject-toSubject ToExecution of the term in the contract is conditional on the execution of other actions.

CodeSystem:FinancialResourceStatusCodes

This value set includes Status codes.
CodeDisplayDefinition
activeActiveThe instance is currently in-force.
cancelledCancelledThe instance is withdrawn, rescinded or reversed.
draftDraftA new instance the contents of which is not complete.
entered-in-errorEntered in ErrorThe instance was entered in error.

CodeSystem:ExampleCoverageFinancialExceptionCodes

This value set includes Example Coverage Financial Exception Codes.
CodeDisplayDefinition
retiredRetiredRetired persons have all copays and deductibles reduced.
fosterFoster childChildren in the foster care have all copays and deductibles waived.

CodeSystem:OralSiteCodes

This value set includes a smattering of FDI oral site codes.
CodeDisplayDefinition
0Oral cavityOral cavity.
11Permanent teeth Maxillary right.
22Permanent teeth Maxillary left.
33Permanent teeth Mandibular right.
44Permanent teeth Mandibular left.
55Deciduous teeth Maxillary right.
66Deciduous teeth Maxillary left.
77Deciduous teeth Mandibular right.
88Deciduous teeth Mandibular left.
1111Upper Right Tooth 1 from the central axis, permanent dentition.
1212Upper Right Tooth 2 from the central axis, permanent dentition.
1313Upper Right Tooth 3 from the central axis, permanent dentition.
1414Upper Right Tooth 4 from the central axis, permanent dentition.
1515Upper Right Tooth 5 from the central axis, permanent dentition.
1616Upper Right Tooth 6 from the central axis, permanent dentition.
1717Upper Right Tooth 7 from the central axis, permanent dentition.
1818Upper Right Tooth 8 from the central axis, permanent dentition.
2121Upper Left Tooth 1 from the central axis, permanent dentition.
2222Upper Left Tooth 2 from the central axis, permanent dentition.
2323Upper Left Tooth 3 from the central axis, permanent dentition.
2424Upper Left Tooth 4 from the central axis, permanent dentition.
2525Upper Left Tooth 5 from the central axis, permanent dentition.
2626Upper Left Tooth 6 from the central axis, permanent dentition.
2727Upper Left Tooth 7 from the central axis, permanent dentition.
2828Upper Left Tooth 8 from the central axis, permanent dentition.
3131Lower Left Tooth 1 from the central axis, permanent dentition.
3232Lower Left Tooth 2 from the central axis, permanent dentition.
3333Lower Left Tooth 3 from the central axis, permanent dentition.
3434Lower Left Tooth 4 from the central axis, permanent dentition.
3535Lower Left Tooth 5 from the central axis, permanent dentition.
3636Lower Left Tooth 6 from the central axis, permanent dentition.
3737Lower Left Tooth 7 from the central axis, permanent dentition.
3838Lower Left Tooth 8 from the central axis, permanent dentition.
4141Lower Right Tooth 1 from the central axis, permanent dentition.
4242Lower Right Tooth 2 from the central axis, permanent dentition.
4343Lower Right Tooth 3 from the central axis, permanent dentition.
4444Lower Right Tooth 4 from the central axis, permanent dentition.
4545Lower Right Tooth 5 from the central axis, permanent dentition.
4646Lower Right Tooth 6 from the central axis, permanent dentition.
4747Lower Right Tooth 7 from the central axis, permanent dentition.
4848Lower Right Tooth 8 from the central axis, permanent dentition.

CodeSystem:ContractResourceScopeCodes

This value set contract specific codes for security category.
CodeDisplayDefinition
policyPolicyTo be completed

CodeSystem:ExampleRelatedClaimRelationshipCodes

This value set includes sample Related Claim Relationship codes.
CodeDisplayDefinition
priorPrior ClaimA prior claim instance for the same intended suite of services.
associatedAssociated ClaimA claim for a different suite of services which is related the suite claimed here.

CodeSystem:ExampleProgramReasonCodes

This value set includes sample Program Reason Span codes.
CodeDisplayDefinition
asChild AsthmaChild Asthma Program
hdHemodialysisHemodialysis Program.
auscrAutism ScreeningAutism Screening Program.
noneNoneNo program code applies.

CodeSystem:ClaimProcessingCodes

This value set includes Claim Processing Outcome codes.
CodeDisplayDefinition
queuedQueuedThe Claim/Pre-authorization/Pre-determination has been received but processing has not begun.
completeProcessing CompleteThe processing has completed without errors
errorErrorOne or more errors have been detected in the Claim
partialPartial ProcessingNo errors have been detected in the Claim and some of the adjudication has been performed.

CodeSystem:BenefitTermCodes

This value set includes a smattering of Benefit Term codes.
CodeDisplayDefinition
annualAnnualAnnual, renewing on the anniversary
dayDayPer day
lifetimeLifetimeFor the total term, lifetime, of the policy or coverage

CodeSystem:ExampleDiagnosisTypeCodes

This value set includes example Diagnosis Type codes.
CodeDisplayDefinition
admittingAdmitting DiagnosisThe diagnosis given as the reason why the patient was admitted to the hospital.
clinicalClinical DiagnosisA diagnosis made on the basis of medical signs and patient-reported symptoms, rather than diagnostic tests.
differentialDifferential DiagnosisOne of a set of the possible diagnoses that could be connected to the signs, symptoms, and lab findings.
dischargeDischarge DiagnosisThe diagnosis given when the patient is discharged from the hospital.
laboratoryLaboratory DiagnosisA diagnosis based significantly on laboratory reports or test results, rather than the physical examination of the patient.
nursingNursing DiagnosisA diagnosis which identifies people's responses to situations in their lives, such as a readiness to change or a willingness to accept assistance.
prenatalPrenatal DiagnosisA diagnosis determined prior to birth.
principalPrincipal DiagnosisThe single medical diagnosis that is most relevant to the patient's chief complaint or need for treatment.
radiologyRadiology DiagnosisA diagnosis based primarily on the results from medical imaging studies.
remoteRemote DiagnosisA diagnosis determined using telemedicine techniques.
retrospectiveRetrospective DiagnosisThe labeling of an illness in a specific historical event using modern knowledge, methods and disease classifications.
selfSelf DiagnosisA diagnosis determined by the patient.

CodeSystem:SurfaceCodes

This value set includes a smattering of FDI tooth surface codes.
CodeDisplayDefinition
MMesialThe surface of a tooth that is closest to the midline (middle) of the face.
OOcclusalThe chewing surface of posterior teeth.
IIncisalThe biting edge of anterior teeth.
DDistalThe surface of a tooth that faces away from the midline of the face.
BBuccalThe surface of a posterior tooth facing the cheeks.
VVentralThe surface of a tooth facing the lips.
LLingualThe surface of a tooth facing the tongue.
MOMesioclusalThe Mesioclusal surfaces of a tooth.
DODistoclusalThe Distoclusal surfaces of a tooth.
DIDistoincisalThe Distoincisal surfaces of a tooth.
MODMesioclusodistalThe Mesioclusodistal surfaces of a tooth.

CodeSystem:Funds Reservation Codes

This value set includes sample funds reservation type codes.
CodeDisplayDefinition
patientPatientThe payor is requested to reserve funds for the provision of the named services by any provider for settlement of future claims related to this request.
providerProviderThe payor is requested to reserve funds solely for the named provider for settlement of future claims related to this request.
noneNoneThe payor is not being requested to reserve any funds for the settlement of future claims.

CodeSystem:ContractResourceAssetAvailiabilityCodes

This value set has asset availability codes.
CodeDisplayDefinition
leaseLeaseTo be completed

CodeSystem:ContractResourceScopeCodes

This value set contract specific codes for security classification.
CodeDisplayDefinition
policyPolicyTo be completed

CodeSystem:ModifierTypeCodes

This value set includes sample Modifier type codes.
CodeDisplayDefinition
aRepair of prior service or installationRepair of prior service or installation.
bTemporary service or installationTemporary service or installation.
cTMJ treatmentTreatment associated with TMJ.
eImplant or associated with an implantImplant or associated with an implant.
roohRush or Outside of office hoursA Rush service or service performed outside of normal office hours.
xNoneNone.

CodeSystem:AdjudicationValueCodes

This value set includes a smattering of Adjudication Value codes which includes codes to indicate the amounts eligible under the plan, the amount of benefit, copays etc.
CodeDisplayDefinition
submittedSubmitted AmountThe total submitted amount for the claim or group or line item.
copayCoPayPatient Co-Payment
eligibleEligible AmountAmount of the change which is considered for adjudication.
deductibleDeductibleAmount deducted from the eligible amount prior to adjudication.
unallocdeductUnallocated DeductibleThe amount of deductible which could not allocated to other line items.
eligpercentEligible %Eligible Percentage.
taxTaxThe amount of tax.
benefitBenefit AmountAmount payable under the coverage

CodeSystem:NoteType

The presentation types of notes.
CodeDisplayDefinition
displayDisplayDisplay the note.
printPrint (Form)Print the note on the form.
printoperPrint (Operator)Print the note for the operator.

CodeSystem:ClaimInformationCategoryCodes

This value set includes sample Information Category codes.
CodeDisplayDefinition
infoInformationCodes conveying additional situation and condition information.
dischargeDischargeDischarge status and discharge to locations.
onsetOnsetPeriod, start or end dates of aspects of the Condition.
relatedRelated ServicesNature and date of the related event e.g. Last exam, service, X-ray etc.
exceptionExceptionInsurance policy exceptions.
materialMaterials ForwardedMaterials being forwarded, e.g. Models, molds, images, documents.
attachmentAttachmentMaterials attached such as images, documents and resources.
missingtoothMissing ToothTeeth which are missing for any reason, for example: prior extraction, never developed.
prosthesisProsthesisThe type of prosthesis and date of supply if a previously supplied prosthesis.
otherOtherOther information identified by the type.system.
hospitalizedHospitalizedAn indication that the patient was hospitalized, the period if known otherwise a Yes/No (boolean).
employmentimpactedEmploymentImpactedAn indication that the patient was unable to work, the period if known otherwise a Yes/No (boolean).
externalcauseExternal CaauseThe external cause of an illness or injury.
patientreasonforvisitPatient Reason for VisitThe reason for the patient visit.

CodeSystem:CoverageClassCodes

This value set includes Coverage Class codes.
CodeDisplayDefinition
groupGroupAn employee group
subgroupSubGroupA sub-group of an employee group
planPlanA specific suite of benefits.
subplanSubPlanA subset of a specific suite of benefits.
classClassA class of benefits.
subclassSubClassA subset of a class of benefits.
sequenceSequenceA sequence number associated with a short-term continuance of the coverage.
rxbinRX BINPharmacy benefit manager's Business Identification Number.
rxpcnRX PCNA Pharmacy Benefit Manager specified Processor Control Number.
rxidRX IdA Pharmacy Benefit Manager specified Member ID.
rxgroupRX GroupA Pharmacy Benefit Manager specified Group number.

CodeSystem:CoverageCopayTypeCodes

This value set includes sample Coverage Copayment Type codes.
CodeDisplayDefinition
gpvisitGP Office VisitAn office visit for a general practitioner of a discipline.
spvisitSpecialist Office VisitAn office visit for a specialist practitioner of a discipline
emergencyEmergencyAn episode in an emergency department.
inpthospInpatient HospitalAn episode of an Inpatient hospital stay.
televisitTele-visitA visit held where the patient is remote relative to the practitioner, e.g. by phone, computer or video conference.
urgentcareUrgent CareA visit to an urgent care facility - typically a community care clinic.
copaypctCopay PercentageA standard percentage applied to all classes or service or product not otherwise specified.
copayCopay AmountA standard fixed currency amount applied to all classes or service or product not otherwise specified.
deductibleDeductibleThe accumulated amount of patient payment before the coverage begins to pay for services.
maxoutofpocketMaximum out of pocketThe maximum amout of payment for services which a patient, or family, is expected to incur - typically annually.

CodeSystem:ICD-10ProcedureCodes

This value set includes sample ICD-10 Procedure codes.
CodeDisplayDefinition
123001PROC-1Procedure 1
123002PROC-2Procedure 2
123003PROC-3Procedure 3

CodeSystem:ContractContentDerivationCodes

This is an example set of Content Derivative type codes, which represent the minimal content derived from the basal information source at a specific stage in its lifecycle, which is sufficient to manage that source information, for example, in a repository, registry, processes and workflows, for making access control decisions, and providing query responses.
CodeDisplayDefinition
registrationContent RegistrationContent derivative that conveys sufficient information needed to register the source basal content from which it is derived. This derivative content may be used to register the basal content as it changes status in its lifecycle. For example, content registration may occur when the basal content is created, updated, inactive, or deleted.
retrievalContent RetrievalA content derivative that conveys sufficient information to locate and retrieve the content.
statementContent StatementContent derivative that has less than full fidelity to the basal information source from which it was 'transcribed'. It provides recipients with the full content representation they may require for compliance purposes, and typically include a reference to or an attached unstructured representation for recipients needing an exact copy of the legal agreement.
shareableShareable ContentA Content Derivative that conveys sufficient information to determine the authorized entities with which the content may be shared.

CodeSystem:ExampleServicePlaceCodes

This value set includes a smattering of Service Place codes.
CodeDisplayDefinition
01PharmacyA facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients.
03SchoolA facility whose primary purpose is education.
04Homeless ShelterA facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters).
05Indian Health Service Free-standing FacilityA facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to American Indians and Alaska Natives who do not require hospitalization.
06Indian Health Service Provider-based FacilityA facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients.
07Tribal 638 Free-Standing FacilityA facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to tribal members who do not require hospitalization.
08Tribal 638 Provider-Based FacilityA facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and nonsurgical), and rehabilitation services to tribal members admitted as inpatients or outpatients.
09Prison/Correctional FacilityA prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders.
11OfficeLocation, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.
12HomeLocation, other than a hospital or other facility, where the patient receives care in a private residence.
13Assisted Living FaCongregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services.
14Group HomeA residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration).
15Mobile UnitA facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services.
19Off Campus-Outpatient Hospitalportion of an off-campus hospital provider-based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
20Urgent Care FacilityLocation, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention.
21Inpatient HospitalA facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical conditions.
41Ambulance—LandA land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured.

CodeSystem:ContractTermSubtypeCodes

This value set includes sample Contract Term SubType codes.
CodeDisplayDefinition
conditionConditionTerms that go to the very root of a contract.
warrantyWarrantyLess imperative than a condition, so the contract will survive a breach
innominateInnominateBreach of which might or might not go to the root of the contract depending upon the nature of the breach

CodeSystem:ContractResourceActionStatusCodes

This value set contract specific codes for action status.
CodeDisplayDefinition
completeCompleteTo be completed

CodeSystem:EligibilityRequestPurpose

A code specifying the types of information being requested.
CodeDisplayDefinition
auth-requirementsCoverage auth-requirementsThe prior authorization requirements for the listed, or discovered if specified, converages for the categories of service and/or specifed biling codes are requested.
benefitsCoverage benefitsThe plan benefits and optionally benefits consumed for the listed, or discovered if specified, converages are requested.
discoveryCoverage DiscoveryThe insurer is requested to report on any coverages which they are aware of in addition to any specifed.
validationCoverage ValidationA check that the specified coverages are in-force is requested.

CodeSystem:ExampleRevenueCenterCodes

This value set includes sample Revenue Center codes.
CodeDisplayDefinition
0370AnaesthesiaAnaesthesia.
0420Physical TherapyPhysical Therapy.
0421Physical Therapy - Physical Therapy - visit charge.
0440Speech-Language PathologySpeech-Language Pathology.
0441Speech-Language Pathology - VisitSpeech-Language Pathology- visit charge
0450Emergency RoomEmergency Room
0451Emergency Room - EM/EMTALAEmergency Room - EM/EMTALA
0452Emergency Room - beyond EMTALAEmergency Room - beyond EMTALA
0010Vision ClinicVision Clinic

CodeSystem:ContractResourceExpirationTypeCodes

This value set contract specific codes for status.
CodeDisplayDefinition
breachBreachTo be completed

CodeSystem:BenefitTypeCodes

This value set includes a smattering of Benefit type codes.
CodeDisplayDefinition
benefitBenefitMaximum benefit allowable.
deductibleDeductibleCost to be incurred before benefits are applied
visitVisitService visit
roomRoomType of room
copayCopayment per serviceCopayment per service
copay-percentCopayment Percent per serviceCopayment percentage per service
copay-maximumCopayment maximum per serviceCopayment maximum per service
vision-examVision ExamVision Exam
vision-glassesVision GlassesFrames and lenses
vision-contactsVision Contacts CoverageContact Lenses
medical-primarycareMedical Primary Health CoverageMedical Primary Health Coverage
pharmacy-dispensePharmacy Dispense CoveragePharmacy Dispense Coverage

CodeSystem:ClaimCareTeamRoleCodes

This value set includes sample Claim Care Team Role codes.
CodeDisplayDefinition
primaryPrimary providerThe primary care provider.
assistAssisting ProviderAssisting care provider.
supervisorSupervising ProviderSupervising care provider.
otherOtherOther role on the care team.

CodeSystem:MissingToothReasonCodes

This value set includes sample Missing Tooth Reason codes.
CodeDisplayDefinition
eEExtraction
cCCongenital
uUUnknown
oOOther

CodeSystem:ExampleDiagnosisRelatedGroupCodes

This value set includes example Diagnosis Related Group codes.
CodeDisplayDefinition
100Normal Vaginal DeliveryNormal Vaginal Delivery.
101Appendectomy - uncomplicatedAppendectomy without rupture or other complications.
300Tooth abscessEmergency department treatment of a tooth abscess.
400Head trauma - concussionHead trauma - concussion.

CodeSystem:ContractActorRoleCodes

This value set includes sample Contract Actor Role codes.
CodeDisplayDefinition
practitionerPractitionerSomeone who provides health care related services to people or animals including both clinical and support services.
patientPatientA receiver, human or animal, of health care related goods and services.

CodeSystem:ExceptionCodes

This value set includes sample Exception codes.
CodeDisplayDefinition
studentStudent (Fulltime)Fulltime Student
disabledDisabledDisabled

CodeSystem:ProcessPriorityCodes

This value set includes the financial processing priority codes.
CodeDisplayDefinition
statImmediateImmediately in real time.
normalNormalWith best effort.
deferredDeferredLater, when possible.

CodeSystem:ContractResourceScopeCodes

This value set contract specific codes for scope.
CodeDisplayDefinition
policyPolicyTo be completed

CodeSystem:ContractTypeCodes

This value set includes sample Contract Type codes.
CodeDisplayDefinition
privacyPrivacyPrivacy policy.
disclosureDisclosureInformation disclosure policy.
healthinsuranceHealth InsuranceHealth Insurance policy.
supplySupply ContractContract to supply goods or services.
consentConsentConsent Directive.

CodeSystem:ProvenanceParticipantType

The type of participation a provenance participant.
CodeDisplayDefinition
entererEntererA person entering the data into the originating system
performerPerformerA person, animal, organization or device that who actually and principally carries out the activity
authorAuthorA party that originates the resource and therefore has responsibility for the information given in the resource and ownership of this resource
verifierVerifierA person who verifies the correctness and appropriateness of activity
attesterAttesterA verifier who attests to the accuracy of the resource
informantInformantA person who reported information that contributed to the resource
custodianCustodianThe entity that is accountable for maintaining a true an accurate copy of the original record
assemblerAssemblerA device that operates independently of an author on custodian's algorithms for data extraction of existing information for purpose of generating a new artifact.
composerComposerA device used by an author to record new information, which may also be used by the author to select existing information for aggregation with newly recorded information for the purpose of generating a new artifact.

CodeSystem:ExampleClaimSubTypeCodes

This value set includes sample Claim SubType codes which are used to distinguish the claim types for example within type institutional there may be subtypes for emergency services, bed stay and transportation.
CodeDisplayDefinition
orthoOrthodontic ClaimA claim for Orthodontic Services.
emergencyEmergency ClaimA claim for emergency services.

CodeSystem:ContractSubtypeCodes

This value set includes sample Contract Subtype codes.
CodeDisplayDefinition
disclosure-caDisclosure-CACanadian health information disclosure policy.
disclosure-usDisclosure-USUnited States health information disclosure policy.

CodeSystem:PaymentTypeCodes

This value set includes sample Payment Type codes.
CodeDisplayDefinition
paymentPaymentThe amount is partial or complete settlement of the amounts due.
adjustmentAdjustmentThe amount is an adjustment regarding claims already paid.
advanceAdvanceThe amount is an advance against future claims.

CodeSystem:ContractResourceStatusCodes

This value set contract specific codes for status.
CodeDisplayDefinition
amendedAmendedContract is augmented with additional information to correct errors in a predecessor or to updated values in a predecessor. Usage: Contract altered within effective time. Precedence Order = 9. Comparable FHIR and v.3 status codes: revised; replaced.
appendedAppendedContract is augmented with additional information that was missing from a predecessor Contract. Usage: Contract altered within effective time. Precedence Order = 9. Comparable FHIR and v.3 status codes: updated, replaced.
cancelledCancelledContract is terminated due to failure of the Grantor and/or the Grantee to fulfil one or more contract provisions. Usage: Abnormal contract termination. Precedence Order = 10. Comparable FHIR and v.3 status codes: stopped; failed; aborted.
disputedDisputedContract is pended to rectify failure of the Grantor or the Grantee to fulfil contract provision(s). E.g., Grantee complaint about Grantor's failure to comply with contract provisions. Usage: Contract pended. Precedence Order = 7. Comparable FHIR and v.3 status codes: on hold; pended; suspended.
entered-in-errorEntered in ErrorContract was created in error. No Precedence Order. Status may be applied to a Contract with any status.
executableExecutableContract execution pending; may be executed when either the Grantor or the Grantee accepts the contract provisions by signing. I.e., where either the Grantor or the Grantee has signed, but not both. E.g., when an insurance applicant signs the insurers application, which references the policy. Usage: Optional first step of contract execution activity. May be skipped and contracting activity moves directly to executed state. Precedence Order = 3. Comparable FHIR and v.3 status codes: draft; preliminary; planned; intended; active.
executedExecutedContract is activated for period stipulated when both the Grantor and Grantee have signed it. Usage: Required state for normal completion of contracting activity. Precedence Order = 6. Comparable FHIR and v.3 status codes: accepted; completed.
negotiableNegotiableContract execution is suspended while either or both the Grantor and Grantee propose and consider new or revised contract provisions. I.e., where the party which has not signed proposes changes to the terms. E .g., a life insurer declines to agree to the signed application because the life insurer has evidence that the applicant, who asserted to being younger or a non-smoker to get a lower premium rate - but offers instead to agree to a higher premium based on the applicants actual age or smoking status. Usage: Optional contract activity between executable and executed state. Precedence Order = 4. Comparable FHIR and v.3 status codes: in progress; review; held.
offeredOfferedContract is a proposal by either the Grantor or the Grantee. Aka - A Contract hard copy or electronic 'template', 'form' or 'application'. E.g., health insurance application; consent directive form. Usage: Beginning of contract negotiation, which may have been completed as a precondition because used for 0..* contracts. Precedence Order = 2. Comparable FHIR and v.3 status codes: requested; new.
policyPolicyContract template is available as the basis for an application or offer by the Grantor or Grantee. E.g., health insurance policy; consent directive policy. Usage: Required initial contract activity, which may have been completed as a precondition because used for 0..* contracts. Precedence Order = 1. Comparable FHIR and v.3 status codes: proposed; intended.
rejectedRejected Execution of the Contract is not completed because either or both the Grantor and Grantee decline to accept some or all of the contract provisions. Usage: Optional contract activity between executable and abnormal termination. Precedence Order = 5. Comparable FHIR and v.3 status codes: stopped; cancelled.
renewedRenewedBeginning of a successor Contract at the termination of predecessor Contract lifecycle. Usage: Follows termination of a preceding Contract that has reached its expiry date. Precedence Order = 13. Comparable FHIR and v.3 status codes: superseded.
revokedRevokedA Contract that is rescinded. May be required prior to replacing with an updated Contract. Comparable FHIR and v.3 status codes: nullified.
resolvedResolvedContract is reactivated after being pended because of faulty execution. *E.g., competency of the signer(s), or where the policy is substantially different from and did not accompany the application/form so that the applicant could not compare them. Aka - ''reactivated''. Usage: Optional stage where a pended contract is reactivated. Precedence Order = 8. Comparable FHIR and v.3 status codes: reactivated.
terminatedTerminatedContract reaches its expiry date. It might or might not be renewed or renegotiated. Usage: Normal end of contract period. Precedence Order = 12. Comparable FHIR and v.3 status codes: Obsoleted.

CodeSystem:ExamplePaymentTypeCodes

This value set includes example Payment Type codes.
CodeDisplayDefinition
completeCompleteComplete (final) payment of the benefit under the Claim less any adjustments.
partialPartialPartial payment of the benefit under the Claim less any adjustments.

CodeSystem:ContractResourceDecisionModeCodes

This value set contract specific codes for decision modes.
CodeDisplayDefinition
policyPolicyTo be completed

CodeSystem:ContractSignerTypeCodes

This value set includes sample Contract Signer Type codes.
CodeDisplayDefinition
AMENDERAmenderA person who has corrected, edited, or amended pre-existing information.
AUTHNAuthenticatorA person in the role of verifier who attests to the accuracy of an act, but who does not have privileges to legally authenticate information content. An example would be a resident physician who sees a patient and dictates a note, then later signs it. The resident's signature constitutes an authentication.
AUTAuthorAn entity that authored specific content. There can be multiple authors of content, which may take such forms as a contract, a healthcare record entry or document, a policy, or a consent directive.
AFFLAffiliateAn entity that has a business or professional relationship with another entity in accordance with an agreement.
AGNTAgentAn entity that acts or is authorized to act on behalf of another entity in accordance with an agreement.
ASSIGNEDAssigned EntityAn agent role in which the agent is an Entity acting in the employ of an organization. The focus is on functional role on behalf of the organization, unlike the Employee role where the focus is on the 'Human Resources' relationship between the employee and the organization.
CITCitizenThe member of a jurisdiction afforded certain rights and encumbered with certain obligation in accordance with jurisdictional policy.
CLAIMANTClaimantA party that makes a claim for coverage under a policy.
COAUTHCo-AuthorThe entity that co-authored content. There can be multiple co-authors of content, which may take such forms as a contract, a healthcare record entry or document, a policy, or a consent directive.
CONSENTERConsenterA patient or patient representative who is the grantee in a healthcare related agreement such as a consent for healthcare services, advanced directive, or a privacy consent directive in accordance with jurisdictional, organizational, or patient policy.
CONSWITConsent WitnessA person who has witnessed and attests to observing a patient being counseled about a healthcare related agreement such as a consent for healthcare services, advanced directive, or a privacy consent directive.
CONTContactA person or an organization that provides or receives information regarding another entity. Examples; patient NOK and emergency contacts; guarantor contact; employer contact.
COPARTCo-ParticipantA person who participates in the generation of and attest to veracity of content but is not an author or co-author. For example, a surgeon who is required by institutional, regulatory, or legal rules to sign an operative report, but who was not involved in the authorship of that report.
COVPTYCovered PartyAn entity, which is the insured, that receives benefits such as healthcare services, reimbursement for out-of-pocket expenses, or compensation for losses through coverage under the terms of an insurance policy. The underwriter of that policy is the scoping entity. The covered party receives coverage because of some contractual or other relationship with the holder of that policy. Note that a particular policy may cover several individuals one of whom may be, but need not be, the policy holder. Thus the notion of covered party is a role that is distinct from that of the policy holder.
DELEGATEEDelegateeA party to whom some right or authority is delegated by a delegator.
delegatorDelegatorA party that delegates a right or authority to another party.
DEPENDDependentA person covered under an insurance policy or program based on an association with a subscriber, which is recognized by the policy holder. The dependent has an association with the subscriber such as a financial dependency or personal relationship such as that of a spouse, or a natural or adopted child. The policy holder may be required by law to recognize certain associations or may have discretion about the associations. For example, a policy holder may dictate the criteria for the dependent status of adult children who are students, such as requiring full time enrollment, or may recognize domestic partners as dependents. Under certain circumstances, the dependent may be under the indirect authority of a responsible party acting as a surrogate for the subscriber, for example, if the subscriber is differently-abled or deceased, a guardian ad lidem or estate executor may be appointed to assume the subscriber's legal standing in the relationship with the dependent.
DPOWATTDurable Power of AttorneyA person who has been granted the authority to represent or act on another's behalf generally in a manner which is a legally binding upon the person giving such authority as if he or she personally were to do the acts. Unlike ordinary powers of attorney, durable powers can survive for long periods of time, and again, unlike standard powers of attorney, durable powers can continue after incompetency.
EMGCONEmergency ContactAn entity to be contacted in the event of an emergency
EVTWITEvent WitnessA person who attests to observing an occurrence. For example, the witness has observed a procedure and is attesting to this fact.
EXCESTExecutor of EstateA person who has been granted the authority to act as an estate executor for a deceased person who was the responsible party.
GRANTEEGranteeA person who grants to another person the authority to represent or act on that person's behalf. Examples include (1) exercising specific rights belonging to the grantee; (2) performing specific duties on behalf of a grantee; and (3) making specific decisions concerning a grantee.
GRANTORGrantorA person who has been granted the authority to represent or act on another's behalf. Examples include (1) exercising specific rights belonging to the grantee; (2) performing specific duties on behalf of a grantee; and (3) making specific decisions concerning a grantee.
GUARGuarantorA person or organization contractually recognized by the issuer as an entity that has assumed fiscal responsibility (e.g., by making or giving a promise, assurance, or pledge) for another entity's financial obligations by guaranteeing to pay for amounts owed to a particular account. In a healthcare context, the account may be a patient's billing account for services rendered by a provider or a health plan premium account.
GUARDGuardianA person or organization legally empowered with responsibility for the care of a ward.
GUADLTMGuardian ad lidemA person appointed by the court to look out for the best interests of a minor child during the course of legal proceedings.
INFInformantAn entity that is the source of reported information (e.g., a next of kin who answers questions about the patient's history). For history questions, the patient is logically an informant, yet the informant of history questions is implicitly the subject.
INTPRTInterpreterA person who converts spoken or written language into the language of key participants in an event such as when a provider is obtaining a patient's consent to treatment or permission to disclose information.
INSBJInvestigation SubjectAn entity that is the subject of an investigation. This role is scoped by the party responsible for the investigation.
HPOWATTHealthcare Power of AttorneyA person who has been granted the authority to represent or act on another's behalf for healthcare related matters in a manner which is a legally binding upon the person giving such authority as if he or she personally were to do the acts. Examples include (1) exercising specific healthcare legal rights belonging to the grantee such as signing a consent directive; (2) performing specific healthcare related legal duties on behalf of a grantee such as claims payment; and (3) making specific healthcare legal decisions concerning a grantee such as consenting to healthcare services.
HPROVHealthcare ProviderAn entity that is authorized to provide health care services by an authorizing organization or jurisdiction.
LEGAUTHNLegal AuthenticatorA person in the role of verifier who attests to the accuracy of information content, and who has privileges to certify the legal authenticity of that content with a signature that constitutes a legal authentication. For example, a licensed physician who signs a consult authored by a resident physician who authenticated it.
NMDINSNamed InsuredA party to an insurance policy under which the insurer agrees to indemnify for losses, provides benefits for, or renders services. A named insured may be either a person, non-person living subject, or an organization, or a group of persons, non-person living subject that is the named insured under a comprehensive automobile, disability, or property and casualty policy. The named insured and might or might not be the policy holder.
NOKNext of KinA person, who is a type of contact, designated to receive notifications on behalf of another person who is a relative.
NOTARYNotaryThe party credentialed to legally attest to the contract binding by verifying the identity and capacity of the grantor and grantee, and witnessing their signing of the contract or agreement such as a real estate transaction, pre-nuptial agreement, or a will.
PATPatientA person, animal, or other living subject that is the actual or potential recipient of health care services.
POWATTPower of AttorneyA person who has been granted the authority to represent or act on another's behalf generally in a manner which is a legally binding upon the person giving such authority as if he or she personally were to do the acts. Examples include (1) exercising specific legal rights belonging to the grantee such as signing a contract; (2) performing specific legal duties on behalf of a grantee such as making loan payments; and (3) making specific legal decisions concerning a grantee such as financial investment decisions.
PRIMAUTHPrimary AuthorAn entity that is the primary or sole author of information content. In the healthcare context, there can be only one primary author of health information content in a record entry or document.
PRIRECIPPrimary Responsible Party An entity that may, should receive, or has received information or an object to which it was primarily addressed.
RECIPRecipientAn entity that may, should receive, or has received information or an object, which might not have been primarily addressed to it. For example, the staff of a provider, a clearinghouse, or other intermediary.
RESPRSNResponsible PartyAn entity that has legal responsibility for another party.
REVIEWERReviewerA person, device, or algorithm that has used approved criteria for filtered data for inclusion into the patient record. Examples: (1) a medical records clerk who scans a document for inclusion in the medical record, enters header information, or catalogues and classifies the data, or a combination thereof; (2) a gateway that receives data from another computer system and interprets that data or changes its format, or both, before entering it into the patient record.
TRANSTranscriberAn entity entering the data into the originating system. This includes the transcriptionist for dictated text transcribed into electronic form.
SOURCESourceAn automated data source that generates a signature along with content. Examples: (1) the signature for an image that is generated by a device for inclusion in the patient record; (2) the signature for an ECG derived by an ECG system for inclusion in the patient record; (3) the data from a biomedical monitoring device or system that is for inclusion in the patient record.
SPOWATTSpecial Power of AttorneyA person who has been granted the authority to represent or act on another's behalf for a limited set of specific matters in a manner which is a legally binding upon the person giving such authority as if he or she personally were to do the acts. Examples include (1) exercising specific legal rights belonging to the grantee such as drafting a will; (2) performing specific legal duties on behalf of a grantee such as making a reversible mortgage to pay for end of life expenses; and (3) making specific legal decisions concerning a grantee such as managing a trust.
VALIDValidatorA person who validates a health information document for inclusion in the patient record. For example, a medical student or resident is credentialed to perform history or physical examinations and to write progress notes. The attending physician signs the history and physical examination to validate the entry for inclusion in the patient's medical record.
VERFVerifierA person who asserts the correctness and appropriateness of an act or the recording of the act, and is accountable for the assertion that the act or the recording of the act complies with jurisdictional or organizational policy. For example, a physician is required to countersign a verbal order that has previously been recorded in the medical record by a registered nurse who has carried out the verbal order.
WITWitnessA person witnessing the signature of another party. A witness is not knowledgeable about the content being signed, much less approves of anything stated in the content. For example, an advanced directive witness or a witness that a party to a contract signed that certain demographic or financial information is truthful.

CodeSystem:Adjudication Error Codes

This value set includes a smattering of adjudication codes.
CodeDisplayDefinition
a001Missing IdentifierMissing Identifier
a002Missing Creation DateMissing Creation Date

CodeSystem:ProvenanceParticipantRole

The role that a provenance participant played
CodeDisplayDefinition
entererEntererA person entering the data into the originating system
performerPerformerA person, animal, organization or device that who actually and principally carries out the activity
authorAuthorA party that originates the resource and therefore has responsibility for the information given in the resource and ownership of this resource
verifierVerifierA person who verifies the correctness and appropriateness of activity
attesterAttesterA verifier who attests to the accuracy of the resource
informantInformantA person who reported information that contributed to the resource
custodianCustodianThe entity that is accountable for maintaining a true an accurate copy of the original record
assemblerAssemblerA device that operates independently of an author on custodian's algorithms for data extraction of existing information for purpose of generating a new artifact.
composerComposerA device used by an author to record new information, which may also be used by the author to select existing information for aggregation with newly recorded information for the purpose of generating a new artifact.

CodeSystem:USCLSCodes

This value set includes a smattering of USCLS codes.
CodeDisplayDefinition
1101Exam, comp, primaryExam, comp, primary
1102Exam, comp, mixedExam, comp, mixed
1103Exam, comp, permanentExam, comp, permanent
1201Exam, recallExam, recall
1205Exam, emergencyExam, emergency
2101Radiograph, series (12)Radiograph, series (12)
2102Radiograph, series (16)Radiograph, series (16)
2141Radiograph, bitewingRadiograph, bitewing
2601Radiograph, panoramicRadiograph, panoramic
11101Polishing, 1 unitPolishing, 1 unit
11102Polishing, 2 unitPolishing, 2 unit
11103Polishing, 3 unitPolishing, 3 unit
11104Polishing, 4 unitPolishing, 4 unit
21211Amalgam, 1 surfaceAmalgam, 1 surface
21212Amalgam, 2 surfaceAmalgam, 2 surface
27211Crown, PFMCrown, PFM
67211Maryland BridgeMaryland Bridge
99111Lab, commercialLab, commercial
99333Lab, in officeLab, in office
99555ExpenseExpense

CodeSystem:NetworkTypeCodes

This value set includes a smattering of Network type codes.
CodeDisplayDefinition
inIn NetworkServices rendered by a Network provider
outOut of NetworkServices rendered by a provider who is not in the Network

CodeSystem:VisionBase

A coded concept listing the base codes.
CodeDisplayDefinition
upUptop.
downDownbottom.
inIninner edge.
outOutouter edge.

CodeSystem:Use

The purpose of the Claim: predetermination, preauthorization, claim.
CodeDisplayDefinition
claimClaimThe treatment is complete and this represents a Claim for the services.
preauthorizationPreauthorizationThe treatment is proposed and this represents a Pre-authorization for the services.
predeterminationPredeterminationThe treatment is proposed and this represents a Pre-determination for the services.

CodeSystem:ExplanationOfBenefitStatus

A code specifying the state of the resource instance.
CodeDisplayDefinition
activeActiveThe resource instance is currently in-force.
cancelledCancelledThe resource instance is withdrawn, rescinded or reversed.
draftDraftA new resource instance the contents of which is not complete.
entered-in-errorEntered In ErrorThe resource instance was entered in error.

CodeSystem:ClaimTypeCodes

This value set includes Claim Type codes.
CodeDisplayDefinition
institutionalInstitutionalHospital, clinic and typically inpatient claims.
oralOralDental, Denture and Hygiene claims.
pharmacyPharmacyPharmacy claims for goods and services.
professionalProfessionalTypically, outpatient claims from Physician, Psychological, Chiropractor, Physiotherapy, Speech Pathology, rehabilitative, consulting.
visionVisionVision claims for professional services and products such as glasses and contact lenses.

CodeSystem:SubscriberRelationshipCodes

This value set includes codes for the relationship between the Subscriber and the Beneficiary (insured/covered party/patient).
CodeDisplayDefinition
childChildThe Beneficiary is a child of the Subscriber
parentParentThe Beneficiary is a parent of the Subscriber
spouseSpouseThe Beneficiary is a spouse or equivalent of the Subscriber
commonCommon Law SpouseThe Beneficiary is a common law spouse or equivalent of the Subscriber
otherOtherThe Beneficiary has some other relationship the Subscriber
selfSelfThe Beneficiary is the Subscriber
injuredInjured PartyThe Beneficiary is covered under insurance of the subscriber due to an injury.

CodeSystem:Beneficiary Relationship Codes

This value set includes the Patient to subscriber relationship codes.
CodeDisplayDefinition
1SelfThe patient is the subscriber (policy holder)
2SpouseThe patient is the spouse or equivalent of the subscriber (policy holder)
3ChildThe patient is the child of the subscriber (policy holder)
4Common Law SpouseThe patient is the common law spouse of the subscriber (policy holder)
5OtherThe patient has some other relationship, such as parent, to the subscriber (policy holder)

CodeSystem:UnitTypeCodes

This value set includes a smattering of Unit type codes.
CodeDisplayDefinition
individualIndividualA single individual
familyFamilyA family, typically includes self, spouse(s) and children to a defined age

CodeSystem:AdjudicationReasonCodes

This value set includes smattering of Adjudication Reason codes.
CodeDisplayDefinition
ar001Not coveredNot covered
ar002Plan Limit ReachedPlan Limit Reached

CodeSystem:ContractResourceLegalStateCodes

This value set contract specific codes for status.
CodeDisplayDefinition
amendedAmendedContract is augmented with additional information to correct errors in a predecessor or to updated values in a predecessor. Usage: Contract altered within effective time. Precedence Order = 9. Comparable FHIR and v.3 status codes: revised; replaced.
appendedAppendedContract is augmented with additional information that was missing from a predecessor Contract. Usage: Contract altered within effective time. Precedence Order = 9. Comparable FHIR and v.3 status codes: updated, replaced.
cancelledCancelledContract is terminated due to failure of the Grantor and/or the Grantee to fulfil one or more contract provisions. Usage: Abnormal contract termination. Precedence Order = 10. Comparable FHIR and v.3 status codes: stopped; failed; aborted.
disputedDisputedContract is pended to rectify failure of the Grantor or the Grantee to fulfil contract provision(s). E.g., Grantee complaint about Grantor's failure to comply with contract provisions. Usage: Contract pended. Precedence Order = 7. Comparable FHIR and v.3 status codes: on hold; pended; suspended.
entered-in-errorEntered in ErrorContract was created in error. No Precedence Order. Status may be applied to a Contract with any status.
executableExecutableContract execution pending; may be executed when either the Grantor or the Grantee accepts the contract provisions by signing. I.e., where either the Grantor or the Grantee has signed, but not both. E.g., when an insurance applicant signs the insurers application, which references the policy. Usage: Optional first step of contract execution activity. May be skipped and contracting activity moves directly to executed state. Precedence Order = 3. Comparable FHIR and v.3 status codes: draft; preliminary; planned; intended; active.
executedExecutedContract is activated for period stipulated when both the Grantor and Grantee have signed it. Usage: Required state for normal completion of contracting activity. Precedence Order = 6. Comparable FHIR and v.3 status codes: accepted; completed.
negotiableNegotiableContract execution is suspended while either or both the Grantor and Grantee propose and consider new or revised contract provisions. I.e., where the party which has not signed proposes changes to the terms. E .g., a life insurer declines to agree to the signed application because the life insurer has evidence that the applicant, who asserted to being younger or a non-smoker to get a lower premium rate - but offers instead to agree to a higher premium based on the applicants actual age or smoking status. Usage: Optional contract activity between executable and executed state. Precedence Order = 4. Comparable FHIR and v.3 status codes: in progress; review; held.
offeredOfferedContract is a proposal by either the Grantor or the Grantee. Aka - A Contract hard copy or electronic 'template', 'form' or 'application'. E.g., health insurance application; consent directive form. Usage: Beginning of contract negotiation, which may have been completed as a precondition because used for 0..* contracts. Precedence Order = 2. Comparable FHIR and v.3 status codes: requested; new.
policyPolicyContract template is available as the basis for an application or offer by the Grantor or Grantee. E.g., health insurance policy; consent directive policy. Usage: Required initial contract activity, which may have been completed as a precondition because used for 0..* contracts. Precedence Order = 1. Comparable FHIR and v.3 status codes: proposed; intended.
rejectedRejected Execution of the Contract is not completed because either or both the Grantor and Grantee decline to accept some or all of the contract provisions. Usage: Optional contract activity between executable and abnormal termination. Precedence Order = 5. Comparable FHIR and v.3 status codes: stopped; cancelled.
renewedRenewedBeginning of a successor Contract at the termination of predecessor Contract lifecycle. Usage: Follows termination of a preceding Contract that has reached its expiry date. Precedence Order = 13. Comparable FHIR and v.3 status codes: superseded.
revokedRevokedA Contract that is rescinded. May be required prior to replacing with an updated Contract. Comparable FHIR and v.3 status codes: nullified.
resolvedResolvedContract is reactivated after being pended because of faulty execution. *E.g., competency of the signer(s), or where the policy is substantially different from and did not accompany the application/form so that the applicant could not compare them. Aka - ''reactivated''. Usage: Optional stage where a pended contract is reactivated. Precedence Order = 8. Comparable FHIR and v.3 status codes: reactivated.
terminatedTerminatedContract reaches its expiry date. It might or might not be renewed or renegotiated. Usage: Normal end of contract period. Precedence Order = 12. Comparable FHIR and v.3 status codes: Obsoleted.

CodeSystem:ContractResourceAssetTypeCodes

This value set contract specific codes for asset type.
CodeDisplayDefinition
participationParticipationTo be completed

CodeSystem:Claim Payee Type Codes

This value set includes sample Payee Type codes.
CodeDisplayDefinition
subscriberSubscriberThe subscriber (policy holder) will be reimbursed.
providerProviderAny benefit payable will be paid to the provider (Assignment of Benefit).
otherProviderAny benefit payable will be paid to a third party such as a guarrantor.

CodeSystem:ContractResourcePartyRoleCodes

This value set contract specific codes for offer party participation.
CodeDisplayDefinition
flunkyFLunkyTo be completed

CodeSystem:ExampleProviderQualificationCodes

This value set includes sample Provider Qualification codes.
CodeDisplayDefinition
311405DentistDentist General Practitioner (DDS, DDM).
604215OphthalmologistOphthalmologist.
604210OptometristOptometrist.

CodeSystem:Form Codes

This value set includes a sample set of Forms codes.
CodeDisplayDefinition
1Form #1Example: The #1 form to be used when printing this information.
2Form #1Example: The #2 form to be used when printing this information.

CodeSystem:ContractResourceSecurityControlCodes

This value set contract specific codes for security control.
CodeDisplayDefinition
policyPolicyTo be completed

CodeSystem:BenefitCategoryCodes

This value set includes examples of Benefit Category codes.
CodeDisplayDefinition
1Medical CareMedical Care.
2SurgicalSurgical.
3ConsultationConsultation.
4Diagnostic XRayDiagnostic XRay.
5Diagnostic LabDiagnostic Lab.
14Renal SuppliesRenal Supplies excluding Dialysis.
23Diagnostic DentalDiagnostic Dental.
24PeriodonticsPeriodontics.
25RestorativeRestorative.
26EndodonticsEndodontics.
27Maxillofacial ProstheticsMaxillofacial Prosthetics.
28Adjunctive Dental ServicesAdjunctive Dental Services.
30Health Benefit Plan CoverageHealth Benefit Plan Coverage.
35Dental CareDental Care.
36Dental CrownsDental Crowns.
37Dental AccidentDental Accident.
49Hospital Room and BoardHospital Room and Board.
55Major MedicalMajor Medical.
56Medically Related TransportationMedically Related Transportation.
61In-vitro FertilizationIn-vitro Fertilization.
62MRI ScanMRI Scan.
63Donor ProceduresDonor Procedures such as organ harvest.
69MaternityMaternity.
76Renal DialysisRenal dialysis.
F1Medical CoverageMedical Coverage.
F3Dental CoverageDental Coverage.
F4Hearing CoverageHearing Coverage.
F6Vision CoverageVision Coverage.

ValueSet: ExampleProgramReasonCodes

This value set includes sample Program Reason Span codes.

ValueSet: FinancialResourceStatusCodes

This value set includes Status codes.

ValueSet: ExampleProcedureTypeCodes

This value set includes example Procedure Type codes.

ValueSet: ExampleDiagnosisOnAdmissionCodes

This value set includes example Diagnosis on Admission codes.

ValueSet: PaymentAdjustmentReasonCodes

This value set includes smattering of Payment Adjustment Reason codes.

ValueSet: Use

The purpose of the Claim: predetermination, preauthorization, claim.

ValueSet: ContractResourceAssetAvailiabilityCodes

This value set has asset availability codes.

ValueSet: ExceptionCodes

This value set includes sample Exception codes.

ValueSet: ContractResourceScopeCodes

This value set contract specific codes for security category.

ValueSet: ExampleRevenueCenterCodes

This value set includes sample Revenue Center codes.

ValueSet: ContractResourceScopeCodes

This value set contract specific codes for scope.

ValueSet: SurfaceCodes

This value set includes a smattering of FDI tooth surface codes.

ValueSet: Adjudication Error Codes

This value set includes a smattering of adjudication codes.

ValueSet: ClaimPayeeResourceType

The type of Claim payee Resource.

ValueSet: ExampleOnsetType(Reason)Codes

This value set includes sample Service Modifier codes.

ValueSet: ExampleService/ProductCodes

This value set includes a smattering of Service/Product codes.

ValueSet: ExampleDiagnosisTypeCodes

This value set includes example Diagnosis Type codes.

ValueSet: BenefitTermCodes

This value set includes a smattering of Benefit Term codes.

ValueSet: ContractResourceSecurityControlCodes

This value set contract specific codes for security control.

ValueSet: ProcessPriorityCodes

This value set includes the financial processing priority codes.

ValueSet: TeethCodes

This value set includes the FDI Teeth codes.

ValueSet: ExampleServiceModifierCodes

This value set includes sample Service Modifier codes.

ValueSet: ContractResourceAssetScopeCodes

This value set contract specific codes for asset scope.

ValueSet: ContractResourceStatusCodes

This value set contract specific codes for status.

ValueSet: OralProsthoMaterialTypeCodes

This value set includes sample Oral Prosthodontic Material type codes.

ValueSet: ClaimCareTeamRoleCodes

This value set includes sample Claim Care Team Role codes.

ValueSet: UDICodes

This value set includes sample UDI codes.

ValueSet: ExampleRelatedClaimRelationshipCodes

This value set includes sample Related Claim Relationship codes.

ValueSet: ContractResourcePublicationStatusCodes

This value set contract specific codes for status.

ValueSet: ClaimItemTypeCodes

This value set includes sample Item Type codes.

ValueSet: ClaimTypeCodes

This value set includes Claim Type codes.

ValueSet: InvoicePriceComponentType

Codes indicating the kind of the price component.

ValueSet: ClaimInformationCategoryCodes

This value set includes sample Information Category codes.

ValueSet: FinancialTaskInputTypeCodes

This value set includes Financial Task Input Type codes.

ValueSet: ContractSubtypeCodes

This value set includes sample Contract Subtype codes.

ValueSet: ContractResourceDefinitionTypeCodes

This value set contract specific codes for status.

ValueSet: ProvenanceParticipantRole

The role that a provenance participant played

ValueSet: Claim Payee Type Codes

This value set includes sample Payee Type codes.

ValueSet: VisionBase

A coded concept listing the base codes.

ValueSet: OralSiteCodes

This value set includes a smattering of FDI oral site codes.

ValueSet: InterventionCodes

This value set includes sample Intervention codes.

ValueSet: BenefitTypeCodes

This value set includes a smattering of Benefit type codes.

ValueSet: CoverageClassCodes

This value set includes Coverage Class codes.

ValueSet: FinancialTaskCodes

This value set includes Financial Task codes.

ValueSet: ContractResourceScopeCodes

This value set contract specific codes for security classification.

ValueSet: SubscriberRelationshipCodes

This value set includes codes for the relationship between the Subscriber and the Beneficiary (insured/covered party/patient).

ValueSet: ContractContentDerivationCodes

This is an example set of Content Derivative type codes, which represent the minimal content derived from the basal information source at a specific stage in its lifecycle, which is sufficient to manage that source information, for example, in a repository, registry, processes and workflows, for making access control decisions, and providing query responses.

ValueSet: ExampleDiagnosisRelatedGroupCodes

This value set includes example Diagnosis Related Group codes.

ValueSet: PaymentStatusCodes

This value set includes a sample set of Payment Status codes.

ValueSet: InvoiceStatus

Codes identifying the lifecycle stage of an Invoice.

ValueSet: ContractResourceDecisionModeCodes

This value set contract specific codes for decision modes.

ValueSet: CoverageTypeAndSelf-PayCodes

This value set includes Coverage Type codes.

ValueSet: ContractResourceDefinitionSubtypeCodes

This value set contract specific codes for status.

ValueSet: ContractTypeCodes

This value set includes sample Contract Type codes.

ValueSet: ExamplePaymentTypeCodes

This value set includes example Payment Type codes.

ValueSet: BenefitCategoryCodes

This value set includes examples of Benefit Category codes.

ValueSet: USCLSCodes

This value set includes a smattering of USCLS codes.

ValueSet: EligibilityRequestPurpose

A code specifying the types of information being requested.

ValueSet: ExampleServicePlaceCodes

This value set includes a smattering of Service Place codes.

ValueSet: ExampleClaimSubTypeCodes

This value set includes sample Claim SubType codes which are used to distinguish the claim types for example within type institutional there may be subtypes for emergency services, bed stay and transportation.

ValueSet: ModifierTypeCodes

This value set includes sample Modifier type codes.

ValueSet: ContractResourceLegalStateCodes

This value set contract specific codes for status.

ValueSet: FMConditionCodes

This value set includes sample Conditions codes.

ValueSet: NoteType

The presentation types of notes.

ValueSet: ContractResourceExpirationTypeCodes

This value set contract specific codes for status.

ValueSet: NetworkTypeCodes

This value set includes a smattering of Network type codes.

ValueSet: ContractSignerTypeCodes

This value set includes sample Contract Signer Type codes.

ValueSet: ContractTermTypeCodes

This value set includes sample Contract Term Type codes.

ValueSet: ContractActorRoleCodes

This value set includes sample Contract Actor Role codes.

ValueSet: PayeeResourceType

The type of payee Resource.

ValueSet: ContractResourceActionStatusCodes

This value set contract specific codes for action status.

ValueSet: Form Codes

This value set includes a sample set of Forms codes.

ValueSet: ExampleCoverageFinancialExceptionCodes

This value set includes Example Coverage Financial Exception Codes.

ValueSet: Beneficiary Relationship Codes

This value set includes the Patient to subscriber relationship codes.

ValueSet: CoverageSelfPayCodes

This value set includes Coverage SelfPay codes.

ValueSet: ContractResourceAssetSub-TypeCodes

This value set contract specific codes for asset subtype.

ValueSet: Funds Reservation Codes

This value set includes sample funds reservation type codes.

ValueSet: ContractResourcePartyRoleCodes

This value set contract specific codes for offer party participation.

ValueSet: ExplanationOfBenefitStatus

A code specifying the state of the resource instance.

ValueSet: ContractDataMeaning

How a resource reference is interpreted when evaluating contract offers.

ValueSet: ContractResourceAssetTypeCodes

This value set contract specific codes for asset type.

ValueSet: CoverageCopayTypeCodes

This value set includes sample Coverage Copayment Type codes.

ValueSet: MissingToothReasonCodes

This value set includes sample Missing Tooth Reason codes.

ValueSet: AdditionalMaterialCodes

This value set includes sample additional material type codes.

ValueSet: UnitTypeCodes

This value set includes a smattering of Unit type codes.

ValueSet: ClaimProcessingCodes

This value set includes Claim Processing Outcome codes.

ValueSet: ContractResourceAssetContextCodes

This value set contract specific codes for asset context.

ValueSet: ICD-10ProcedureCodes

This value set includes sample ICD-10 Procedure codes.

ValueSet: ExampleVisionPrescriptionProductCodes

This value set includes a smattering of Prescription Product codes.

ValueSet: ExampleProviderQualificationCodes

This value set includes sample Provider Qualification codes.

ValueSet: EligibilityResponsePurpose

A code specifying the types of information being requested.

ValueSet: VisionEyes

A coded concept listing the eye codes.

ValueSet: ContractTermSubtypeCodes

This value set includes sample Contract Term SubType codes.

ValueSet: ExamplePharmacyServiceCodes

This value set includes a smattering of Pharmacy Service codes.

ValueSet: ProvenanceParticipantType

The type of participation a provenance participant.

ValueSet: ICD-10Codes

This value set includes sample ICD-10 codes.

ValueSet: AdjudicationReasonCodes

This value set includes smattering of Adjudication Reason codes.

ValueSet: PaymentTypeCodes

This value set includes sample Payment Type codes.

ValueSet: AdjudicationValueCodes

This value set includes a smattering of Adjudication Value codes which includes codes to indicate the amounts eligible under the plan, the amount of benefit, copays etc.

ValueSet: ContractActionCodes

This value set includes sample Contract Action codes.