Universal API Implementation Guide
1.1.19 - ci-build
Universal API Implementation Guide - Local Development build (v1.1.19). See the Directory of published versions
| Active as of 2020-06-15 |
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:CodeSystem;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "uapi-benefit-type"];
fhir:Resource.meta [
fhir:Meta.lastUpdated [ fhir:value "2021-04-28T05:00:00.000+00:00"^^xsd:dateTime ]
];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system <code>https://fhir.developer.gene.com/CodeSystem/uapi-benefit-type</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td></tr><tr><td style=\"white-space:nowrap\">fullBI<a name=\"uapi-benefit-type-fullBI\"> </a></td><td>Full BI</td></tr><tr><td style=\"white-space:nowrap\">reverify<a name=\"uapi-benefit-type-reverify\"> </a></td><td>Reverify BI Information</td></tr><tr><td style=\"white-space:nowrap\">dateEligibility<a name=\"uapi-benefit-type-dateEligibility\"> </a></td><td>Eligibility Date Only</td></tr><tr><td style=\"white-space:nowrap\">oSource<a name=\"uapi-benefit-type-oSource\"> </a></td><td>Other Source</td></tr><tr><td style=\"white-space:nowrap\">triage<a name=\"uapi-benefit-type-triage\"> </a></td><td>Triage</td></tr><tr><td style=\"white-space:nowrap\">appeals<a name=\"uapi-benefit-type-appeals\"> </a></td><td>Appeals Support</td></tr><tr><td style=\"white-space:nowrap\">deductible<a name=\"uapi-benefit-type-deductible\"> </a></td><td>deductible</td></tr><tr><td style=\"white-space:nowrap\">OOPMax<a name=\"uapi-benefit-type-OOPMax\"> </a></td><td>OOP Max</td></tr><tr><td style=\"white-space:nowrap\">doesIndDedApplyFamily<a name=\"uapi-benefit-type-doesIndDedApplyFamily\"> </a></td><td>does ind ded apply to family</td></tr><tr><td style=\"white-space:nowrap\">FamDedMetBefore<a name=\"uapi-benefit-type-FamDedMetBefore\"> </a></td><td>Must Fam Ded Be Met Before Bene Cov</td></tr><tr><td style=\"white-space:nowrap\">OOPApply<a name=\"uapi-benefit-type-OOPApply\"> </a></td><td>Does OOP Apply</td></tr><tr><td style=\"white-space:nowrap\">IndividualOOPFamily<a name=\"uapi-benefit-type-IndividualOOPFamily\"> </a></td><td>Does Individual OOP Apply to Family</td></tr><tr><td style=\"white-space:nowrap\">100%Cov<a name=\"uapi-benefit-type-100.37Cov\"> </a></td><td>100% Cov only if Family OOP Met</td></tr><tr><td style=\"white-space:nowrap\">InsurerCostShare<a name=\"uapi-benefit-type-InsurerCostShare\"> </a></td><td>Insurer Cost Share %</td></tr><tr><td style=\"white-space:nowrap\">PatientCostShare<a name=\"uapi-benefit-type-PatientCostShare\"> </a></td><td>Patient Cost Share %</td></tr><tr><td style=\"white-space:nowrap\">DrugCo-Pay<a name=\"uapi-benefit-type-DrugCo-Pay\"> </a></td><td>Drug Co-Pay</td></tr><tr><td style=\"white-space:nowrap\">SpecialistCo-Pay<a name=\"uapi-benefit-type-SpecialistCo-Pay\"> </a></td><td>Specialist Co-Pay</td></tr><tr><td style=\"white-space:nowrap\">DeductibleApplyOOP<a name=\"uapi-benefit-type-DeductibleApplyOOP\"> </a></td><td>Does Deductible Apply to OOP</td></tr><tr><td style=\"white-space:nowrap\">MaxBenefit/Year<a name=\"uapi-benefit-type-MaxBenefit.47Year\"> </a></td><td>Max Benefit/Year</td></tr><tr><td style=\"white-space:nowrap\">MaxLifetimeAmount<a name=\"uapi-benefit-type-MaxLifetimeAmount\"> </a></td><td>Max Lifetime Amount</td></tr><tr><td style=\"white-space:nowrap\">BuyBill<a name=\"uapi-benefit-type-BuyBill\"> </a></td><td>Buy and Bill</td></tr><tr><td style=\"white-space:nowrap\">PlaceOfServiceCo-Pay<a name=\"uapi-benefit-type-PlaceOfServiceCo-Pay\"> </a></td><td>Place of Service Co-Pay</td></tr><tr><td style=\"white-space:nowrap\">SpentDownAmount<a name=\"uapi-benefit-type-SpentDownAmount\"> </a></td><td>Spent Down Amount</td></tr><tr><td style=\"white-space:nowrap\">DrugTierLevel<a name=\"uapi-benefit-type-DrugTierLevel\"> </a></td><td>Drug Tier Level</td></tr><tr><td style=\"white-space:nowrap\">DeductibleApply<a name=\"uapi-benefit-type-DeductibleApply\"> </a></td><td>Does Deductible Apply?</td></tr><tr><td style=\"white-space:nowrap\">PatientCostInitial<a name=\"uapi-benefit-type-PatientCostInitial\"> </a></td><td>Patient Cost Share % **Initial Coverage Stage</td></tr><tr><td style=\"white-space:nowrap\">DaysSupplyInitial<a name=\"uapi-benefit-type-DaysSupplyInitial\"> </a></td><td>Day Supply **Initial Coverage Stage</td></tr><tr><td style=\"white-space:nowrap\">DrugCopayInitial<a name=\"uapi-benefit-type-DrugCopayInitial\"> </a></td><td>Drug Copay **Initial Coverage Stage</td></tr><tr><td style=\"white-space:nowrap\">PatientCostCatastrophic<a name=\"uapi-benefit-type-PatientCostCatastrophic\"> </a></td><td>Patient Cost Share % **Catastrophic Coverage Stage</td></tr><tr><td style=\"white-space:nowrap\">DrugCopayCatastrophic<a name=\"uapi-benefit-type-DrugCopayCatastrophic\"> </a></td><td>Drug Co-pay **Catastrophic Coverage Stage</td></tr><tr><td style=\"white-space:nowrap\">CoverageGap<a name=\"uapi-benefit-type-CoverageGap\"> </a></td><td>Coverage Gap</td></tr></table></div>"
];
fhir:CodeSystem.url [ fhir:value "https://fhir.developer.gene.com/CodeSystem/uapi-benefit-type"];
fhir:CodeSystem.version [ fhir:value "1.1.19"];
fhir:CodeSystem.name [ fhir:value "UapiCodeSystemBenefitType"];
fhir:CodeSystem.title [ fhir:value "UAPI Code System - Benefit Type"];
fhir:CodeSystem.status [ fhir:value "active"];
fhir:CodeSystem.experimental [ fhir:value "false"^^xsd:boolean];
fhir:CodeSystem.date [ fhir:value "2020-06-15T00:00:00-05:00"^^xsd:dateTime];
fhir:CodeSystem.publisher [ fhir:value "Genentech USIX"];
fhir:CodeSystem.contact [
fhir:index 0;
fhir:ContactDetail.name [ fhir:value "Krzysztof Wilczek" ];
fhir:ContactDetail.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "email" ];
fhir:ContactPoint.value [ fhir:value "mailto:wilczekk@gene.com" ] ]
];
fhir:CodeSystem.description [ fhir:value "Genentech Benefit Types Supported in UAPI"];
fhir:CodeSystem.jurisdiction [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "urn:iso:std:iso:3166" ];
fhir:Coding.code [ fhir:value "US" ];
fhir:Coding.display [ fhir:value "United States of America" ] ]
];
fhir:CodeSystem.caseSensitive [ fhir:value "false"^^xsd:boolean];
fhir:CodeSystem.content [ fhir:value "complete"];
fhir:CodeSystem.count [ fhir:value "31"^^xsd:nonNegativeInteger];
fhir:CodeSystem.concept [
fhir:index 0;
fhir:CodeSystem.concept.code [ fhir:value "fullBI" ];
fhir:CodeSystem.concept.display [ fhir:value "Full BI" ]
], [
fhir:index 1;
fhir:CodeSystem.concept.code [ fhir:value "reverify" ];
fhir:CodeSystem.concept.display [ fhir:value "Reverify BI Information" ]
], [
fhir:index 2;
fhir:CodeSystem.concept.code [ fhir:value "dateEligibility" ];
fhir:CodeSystem.concept.display [ fhir:value "Eligibility Date Only" ]
], [
fhir:index 3;
fhir:CodeSystem.concept.code [ fhir:value "oSource" ];
fhir:CodeSystem.concept.display [ fhir:value "Other Source" ]
], [
fhir:index 4;
fhir:CodeSystem.concept.code [ fhir:value "triage" ];
fhir:CodeSystem.concept.display [ fhir:value "Triage" ]
], [
fhir:index 5;
fhir:CodeSystem.concept.code [ fhir:value "appeals" ];
fhir:CodeSystem.concept.display [ fhir:value "Appeals Support" ]
], [
fhir:index 6;
fhir:CodeSystem.concept.code [ fhir:value "deductible" ];
fhir:CodeSystem.concept.display [ fhir:value "deductible" ]
], [
fhir:index 7;
fhir:CodeSystem.concept.code [ fhir:value "OOPMax" ];
fhir:CodeSystem.concept.display [ fhir:value "OOP Max" ]
], [
fhir:index 8;
fhir:CodeSystem.concept.code [ fhir:value "doesIndDedApplyFamily" ];
fhir:CodeSystem.concept.display [ fhir:value "does ind ded apply to family" ]
], [
fhir:index 9;
fhir:CodeSystem.concept.code [ fhir:value "FamDedMetBefore" ];
fhir:CodeSystem.concept.display [ fhir:value "Must Fam Ded Be Met Before Bene Cov" ]
], [
fhir:index 10;
fhir:CodeSystem.concept.code [ fhir:value "OOPApply" ];
fhir:CodeSystem.concept.display [ fhir:value "Does OOP Apply" ]
], [
fhir:index 11;
fhir:CodeSystem.concept.code [ fhir:value "IndividualOOPFamily" ];
fhir:CodeSystem.concept.display [ fhir:value "Does Individual OOP Apply to Family" ]
], [
fhir:index 12;
fhir:CodeSystem.concept.code [ fhir:value "100%Cov" ];
fhir:CodeSystem.concept.display [ fhir:value "100% Cov only if Family OOP Met" ]
], [
fhir:index 13;
fhir:CodeSystem.concept.code [ fhir:value "InsurerCostShare" ];
fhir:CodeSystem.concept.display [ fhir:value "Insurer Cost Share %" ]
], [
fhir:index 14;
fhir:CodeSystem.concept.code [ fhir:value "PatientCostShare" ];
fhir:CodeSystem.concept.display [ fhir:value "Patient Cost Share %" ]
], [
fhir:index 15;
fhir:CodeSystem.concept.code [ fhir:value "DrugCo-Pay" ];
fhir:CodeSystem.concept.display [ fhir:value "Drug Co-Pay" ]
], [
fhir:index 16;
fhir:CodeSystem.concept.code [ fhir:value "SpecialistCo-Pay" ];
fhir:CodeSystem.concept.display [ fhir:value "Specialist Co-Pay" ]
], [
fhir:index 17;
fhir:CodeSystem.concept.code [ fhir:value "DeductibleApplyOOP" ];
fhir:CodeSystem.concept.display [ fhir:value "Does Deductible Apply to OOP" ]
], [
fhir:index 18;
fhir:CodeSystem.concept.code [ fhir:value "MaxBenefit/Year" ];
fhir:CodeSystem.concept.display [ fhir:value "Max Benefit/Year" ]
], [
fhir:index 19;
fhir:CodeSystem.concept.code [ fhir:value "MaxLifetimeAmount" ];
fhir:CodeSystem.concept.display [ fhir:value "Max Lifetime Amount" ]
], [
fhir:index 20;
fhir:CodeSystem.concept.code [ fhir:value "BuyBill" ];
fhir:CodeSystem.concept.display [ fhir:value "Buy and Bill" ]
], [
fhir:index 21;
fhir:CodeSystem.concept.code [ fhir:value "PlaceOfServiceCo-Pay" ];
fhir:CodeSystem.concept.display [ fhir:value "Place of Service Co-Pay" ]
], [
fhir:index 22;
fhir:CodeSystem.concept.code [ fhir:value "SpentDownAmount" ];
fhir:CodeSystem.concept.display [ fhir:value "Spent Down Amount" ]
], [
fhir:index 23;
fhir:CodeSystem.concept.code [ fhir:value "DrugTierLevel" ];
fhir:CodeSystem.concept.display [ fhir:value "Drug Tier Level" ]
], [
fhir:index 24;
fhir:CodeSystem.concept.code [ fhir:value "DeductibleApply" ];
fhir:CodeSystem.concept.display [ fhir:value "Does Deductible Apply?" ]
], [
fhir:index 25;
fhir:CodeSystem.concept.code [ fhir:value "PatientCostInitial" ];
fhir:CodeSystem.concept.display [ fhir:value "Patient Cost Share % **Initial Coverage Stage" ]
], [
fhir:index 26;
fhir:CodeSystem.concept.code [ fhir:value "DaysSupplyInitial" ];
fhir:CodeSystem.concept.display [ fhir:value "Day Supply **Initial Coverage Stage" ]
], [
fhir:index 27;
fhir:CodeSystem.concept.code [ fhir:value "DrugCopayInitial" ];
fhir:CodeSystem.concept.display [ fhir:value "Drug Copay **Initial Coverage Stage" ]
], [
fhir:index 28;
fhir:CodeSystem.concept.code [ fhir:value "PatientCostCatastrophic" ];
fhir:CodeSystem.concept.display [ fhir:value "Patient Cost Share % **Catastrophic Coverage Stage" ]
], [
fhir:index 29;
fhir:CodeSystem.concept.code [ fhir:value "DrugCopayCatastrophic" ];
fhir:CodeSystem.concept.display [ fhir:value "Drug Co-pay **Catastrophic Coverage Stage" ]
], [
fhir:index 30;
fhir:CodeSystem.concept.code [ fhir:value "CoverageGap" ];
fhir:CodeSystem.concept.display [ fhir:value "Coverage Gap" ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2021+ . Package gene.com.fhir.uapi#1.1.19 based on FHIR 4.3.0. Generated 2024-02-19
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