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 |
<CodeSystem xmlns="http://hl7.org/fhir">
<id value="uapi-benefit-type"/>
<meta>
<lastUpdated value="2021-04-28T05:00:00.000+00:00"/>
</meta>
<text>
<status value="generated"/>
<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>
</text>
<url value="https://fhir.developer.gene.com/CodeSystem/uapi-benefit-type"/>
<version value="1.1.19"/>
<name value="UapiCodeSystemBenefitType"/>
<title value="UAPI Code System - Benefit Type"/>
<status value="active"/>
<experimental value="false"/>
<date value="2020-06-15T00:00:00-05:00"/>
<publisher value="Genentech USIX"/>
<contact>
<name value="Krzysztof Wilczek"/>
<telecom>
<system value="email"/>
<value value="mailto:wilczekk@gene.com"/>
</telecom>
</contact>
<description value="Genentech Benefit Types Supported in UAPI"/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
<display value="United States of America"/>
</coding>
</jurisdiction>
<caseSensitive value="false"/>
<content value="complete"/>
<count value="31"/>
<concept>
<code value="fullBI"/>
<display value="Full BI"/>
</concept>
<concept>
<code value="reverify"/>
<display value="Reverify BI Information"/>
</concept>
<concept>
<code value="dateEligibility"/>
<display value="Eligibility Date Only"/>
</concept>
<concept>
<code value="oSource"/>
<display value="Other Source"/>
</concept>
<concept>
<code value="triage"/>
<display value="Triage"/>
</concept>
<concept>
<code value="appeals"/>
<display value="Appeals Support"/>
</concept>
<concept>
<code value="deductible"/>
<display value="deductible"/>
</concept>
<concept>
<code value="OOPMax"/>
<display value="OOP Max"/>
</concept>
<concept>
<code value="doesIndDedApplyFamily"/>
<display value="does ind ded apply to family"/>
</concept>
<concept>
<code value="FamDedMetBefore"/>
<display value="Must Fam Ded Be Met Before Bene Cov"/>
</concept>
<concept>
<code value="OOPApply"/>
<display value="Does OOP Apply"/>
</concept>
<concept>
<code value="IndividualOOPFamily"/>
<display value="Does Individual OOP Apply to Family"/>
</concept>
<concept>
<code value="100%Cov"/>
<display value="100% Cov only if Family OOP Met"/>
</concept>
<concept>
<code value="InsurerCostShare"/>
<display value="Insurer Cost Share %"/>
</concept>
<concept>
<code value="PatientCostShare"/>
<display value="Patient Cost Share %"/>
</concept>
<concept>
<code value="DrugCo-Pay"/>
<display value="Drug Co-Pay"/>
</concept>
<concept>
<code value="SpecialistCo-Pay"/>
<display value="Specialist Co-Pay"/>
</concept>
<concept>
<code value="DeductibleApplyOOP"/>
<display value="Does Deductible Apply to OOP"/>
</concept>
<concept>
<code value="MaxBenefit/Year"/>
<display value="Max Benefit/Year"/>
</concept>
<concept>
<code value="MaxLifetimeAmount"/>
<display value="Max Lifetime Amount"/>
</concept>
<concept>
<code value="BuyBill"/>
<display value="Buy and Bill"/>
</concept>
<concept>
<code value="PlaceOfServiceCo-Pay"/>
<display value="Place of Service Co-Pay"/>
</concept>
<concept>
<code value="SpentDownAmount"/>
<display value="Spent Down Amount"/>
</concept>
<concept>
<code value="DrugTierLevel"/>
<display value="Drug Tier Level"/>
</concept>
<concept>
<code value="DeductibleApply"/>
<display value="Does Deductible Apply?"/>
</concept>
<concept>
<code value="PatientCostInitial"/>
<display value="Patient Cost Share % **Initial Coverage Stage"/>
</concept>
<concept>
<code value="DaysSupplyInitial"/>
<display value="Day Supply **Initial Coverage Stage"/>
</concept>
<concept>
<code value="DrugCopayInitial"/>
<display value="Drug Copay **Initial Coverage Stage"/>
</concept>
<concept>
<code value="PatientCostCatastrophic"/>
<display value="Patient Cost Share % **Catastrophic Coverage Stage"/>
</concept>
<concept>
<code value="DrugCopayCatastrophic"/>
<display value="Drug Co-pay **Catastrophic Coverage Stage"/>
</concept>
<concept>
<code value="CoverageGap"/>
<display value="Coverage Gap"/>
</concept>
</CodeSystem>
IG © 2021+ . Package gene.com.fhir.uapi#1.1.19 based on FHIR 4.3.0. Generated 2024-02-19
Links: Table of Contents |
QA Report