Universal API Implementation Guide
1.1.20 - ci-build
Universal API Implementation Guide - Local Development build (v1.1.20) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Active as of 2020-06-15 |
{
"resourceType" : "CodeSystem",
"id" : "uapi-benefit-type",
"meta" : {
"lastUpdated" : "2021-04-28T05:00:00.000+00:00"
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem uapi-benefit-type</b></p><a name=\"uapi-benefit-type\"> </a><a name=\"hcuapi-benefit-type\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Last updated: 2021-04-28 05:00:00+0000</p></div><p>This case-insensitive 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>"
},
"url" : "https://fhir.developer.gene.com/CodeSystem/uapi-benefit-type",
"version" : "1.1.20",
"name" : "UapiCodeSystemBenefitType",
"title" : "UAPI Code System - Benefit Type",
"status" : "active",
"experimental" : false,
"date" : "2020-06-15T00:00:00-05:00",
"contact" : [
{
"name" : "Krzysztof Wilczek",
"telecom" : [
{
"system" : "email",
"value" : "mailto:wilczekk@gene.com"
}
]
}
],
"description" : "Genentech Benefit Types Supported in UAPI",
"caseSensitive" : false,
"content" : "complete",
"count" : 31,
"concept" : [
{
"code" : "fullBI",
"display" : "Full BI"
},
{
"code" : "reverify",
"display" : "Reverify BI Information"
},
{
"code" : "dateEligibility",
"display" : "Eligibility Date Only"
},
{
"code" : "oSource",
"display" : "Other Source"
},
{
"code" : "triage",
"display" : "Triage"
},
{
"code" : "appeals",
"display" : "Appeals Support"
},
{
"code" : "deductible",
"display" : "deductible"
},
{
"code" : "OOPMax",
"display" : "OOP Max"
},
{
"code" : "doesIndDedApplyFamily",
"display" : "does ind ded apply to family"
},
{
"code" : "FamDedMetBefore",
"display" : "Must Fam Ded Be Met Before Bene Cov"
},
{
"code" : "OOPApply",
"display" : "Does OOP Apply"
},
{
"code" : "IndividualOOPFamily",
"display" : "Does Individual OOP Apply to Family"
},
{
"code" : "100%Cov",
"display" : "100% Cov only if Family OOP Met"
},
{
"code" : "InsurerCostShare",
"display" : "Insurer Cost Share %"
},
{
"code" : "PatientCostShare",
"display" : "Patient Cost Share %"
},
{
"code" : "DrugCo-Pay",
"display" : "Drug Co-Pay"
},
{
"code" : "SpecialistCo-Pay",
"display" : "Specialist Co-Pay"
},
{
"code" : "DeductibleApplyOOP",
"display" : "Does Deductible Apply to OOP"
},
{
"code" : "MaxBenefit/Year",
"display" : "Max Benefit/Year"
},
{
"code" : "MaxLifetimeAmount",
"display" : "Max Lifetime Amount"
},
{
"code" : "BuyBill",
"display" : "Buy and Bill"
},
{
"code" : "PlaceOfServiceCo-Pay",
"display" : "Place of Service Co-Pay"
},
{
"code" : "SpentDownAmount",
"display" : "Spent Down Amount"
},
{
"code" : "DrugTierLevel",
"display" : "Drug Tier Level"
},
{
"code" : "DeductibleApply",
"display" : "Does Deductible Apply?"
},
{
"code" : "PatientCostInitial",
"display" : "Patient Cost Share % **Initial Coverage Stage"
},
{
"code" : "DaysSupplyInitial",
"display" : "Day Supply **Initial Coverage Stage"
},
{
"code" : "DrugCopayInitial",
"display" : "Drug Copay **Initial Coverage Stage"
},
{
"code" : "PatientCostCatastrophic",
"display" : "Patient Cost Share % **Catastrophic Coverage Stage"
},
{
"code" : "DrugCopayCatastrophic",
"display" : "Drug Co-pay **Catastrophic Coverage Stage"
},
{
"code" : "CoverageGap",
"display" : "Coverage Gap"
}
]
}