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

: UAPI Code System - Benefit Type - TTL Representation

Active as of 2020-06-15

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@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:id [ fhir:v "uapi-benefit-type"] ; # 
  fhir:meta [
fhir:lastUpdated [ fhir:v "2021-04-28T05:00:00.000+00:00"^^xsd:dateTime ]
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir: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>"^^rdf:XMLLiteral
  ] ; # 
  fhir:url [ fhir:v "https://fhir.developer.gene.com/CodeSystem/uapi-benefit-type"^^xsd:anyURI] ; # 
  fhir:version [ fhir:v "1.1.20"] ; # 
  fhir:name [ fhir:v "UapiCodeSystemBenefitType"] ; # 
  fhir:title [ fhir:v "UAPI Code System - Benefit Type"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:experimental [ fhir:v false] ; # 
  fhir:date [ fhir:v "2020-06-15T00:00:00-05:00"^^xsd:dateTime] ; # 
  fhir:contact ( [
fhir:name [ fhir:v "Krzysztof Wilczek" ] ;
    ( fhir:telecom [
fhir:system [ fhir:v "email" ] ;
fhir:value [ fhir:v "mailto:wilczekk@gene.com" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "Genentech Benefit Types Supported in UAPI"] ; # 
  fhir:caseSensitive [ fhir:v false] ; # 
  fhir:content [ fhir:v "complete"] ; # 
  fhir:count [ fhir:v "31"^^xsd:nonNegativeInteger] ; # 
  fhir:concept ( [
fhir:code [ fhir:v "fullBI" ] ;
fhir:display [ fhir:v "Full BI" ]
  ] [
fhir:code [ fhir:v "reverify" ] ;
fhir:display [ fhir:v "Reverify BI Information" ]
  ] [
fhir:code [ fhir:v "dateEligibility" ] ;
fhir:display [ fhir:v "Eligibility Date Only" ]
  ] [
fhir:code [ fhir:v "oSource" ] ;
fhir:display [ fhir:v "Other Source" ]
  ] [
fhir:code [ fhir:v "triage" ] ;
fhir:display [ fhir:v "Triage" ]
  ] [
fhir:code [ fhir:v "appeals" ] ;
fhir:display [ fhir:v "Appeals Support" ]
  ] [
fhir:code [ fhir:v "deductible" ] ;
fhir:display [ fhir:v "deductible" ]
  ] [
fhir:code [ fhir:v "OOPMax" ] ;
fhir:display [ fhir:v "OOP Max" ]
  ] [
fhir:code [ fhir:v "doesIndDedApplyFamily" ] ;
fhir:display [ fhir:v "does ind ded apply to family" ]
  ] [
fhir:code [ fhir:v "FamDedMetBefore" ] ;
fhir:display [ fhir:v "Must Fam Ded Be Met Before Bene Cov" ]
  ] [
fhir:code [ fhir:v "OOPApply" ] ;
fhir:display [ fhir:v "Does OOP Apply" ]
  ] [
fhir:code [ fhir:v "IndividualOOPFamily" ] ;
fhir:display [ fhir:v "Does Individual OOP Apply to Family" ]
  ] [
fhir:code [ fhir:v "100%Cov" ] ;
fhir:display [ fhir:v "100% Cov only if Family OOP Met" ]
  ] [
fhir:code [ fhir:v "InsurerCostShare" ] ;
fhir:display [ fhir:v "Insurer Cost Share %" ]
  ] [
fhir:code [ fhir:v "PatientCostShare" ] ;
fhir:display [ fhir:v "Patient Cost Share %" ]
  ] [
fhir:code [ fhir:v "DrugCo-Pay" ] ;
fhir:display [ fhir:v "Drug Co-Pay" ]
  ] [
fhir:code [ fhir:v "SpecialistCo-Pay" ] ;
fhir:display [ fhir:v "Specialist Co-Pay" ]
  ] [
fhir:code [ fhir:v "DeductibleApplyOOP" ] ;
fhir:display [ fhir:v "Does Deductible Apply to OOP" ]
  ] [
fhir:code [ fhir:v "MaxBenefit/Year" ] ;
fhir:display [ fhir:v "Max Benefit/Year" ]
  ] [
fhir:code [ fhir:v "MaxLifetimeAmount" ] ;
fhir:display [ fhir:v "Max Lifetime Amount" ]
  ] [
fhir:code [ fhir:v "BuyBill" ] ;
fhir:display [ fhir:v "Buy and Bill" ]
  ] [
fhir:code [ fhir:v "PlaceOfServiceCo-Pay" ] ;
fhir:display [ fhir:v "Place of Service Co-Pay" ]
  ] [
fhir:code [ fhir:v "SpentDownAmount" ] ;
fhir:display [ fhir:v "Spent Down Amount" ]
  ] [
fhir:code [ fhir:v "DrugTierLevel" ] ;
fhir:display [ fhir:v "Drug Tier Level" ]
  ] [
fhir:code [ fhir:v "DeductibleApply" ] ;
fhir:display [ fhir:v "Does Deductible Apply?" ]
  ] [
fhir:code [ fhir:v "PatientCostInitial" ] ;
fhir:display [ fhir:v "Patient Cost Share % **Initial Coverage Stage" ]
  ] [
fhir:code [ fhir:v "DaysSupplyInitial" ] ;
fhir:display [ fhir:v "Day Supply **Initial Coverage Stage" ]
  ] [
fhir:code [ fhir:v "DrugCopayInitial" ] ;
fhir:display [ fhir:v "Drug Copay **Initial Coverage Stage" ]
  ] [
fhir:code [ fhir:v "PatientCostCatastrophic" ] ;
fhir:display [ fhir:v "Patient Cost Share % **Catastrophic Coverage Stage" ]
  ] [
fhir:code [ fhir:v "DrugCopayCatastrophic" ] ;
fhir:display [ fhir:v "Drug Co-pay **Catastrophic Coverage Stage" ]
  ] [
fhir:code [ fhir:v "CoverageGap" ] ;
fhir:display [ fhir:v "Coverage Gap" ]
  ] ) . #