FHIR Implementation Guide for ABDM
6.5.0 - active
FHIR Implementation Guide for ABDM
6.5.0 - active
This page is part of the FHIR Implementation Guide for ABDM (v6.5.0: Release) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
| Draft as of 2023-07-05 |
{
"resourceType" : "CodeSystem",
"id" : "ndhm-claim-exclusion",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem ndhm-claim-exclusion</b></p><a name=\"ndhm-claim-exclusion\"> </a><a name=\"hcndhm-claim-exclusion\"> </a><a name=\"ndhm-claim-exclusion-hi-IN\"> </a><p>This case-sensitive code system <code>https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusion</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\">Excl01<a name=\"ndhm-claim-exclusion-Excl01\"> </a></td><td>Pre-Existing Diseases</td></tr><tr><td style=\"white-space:nowrap\">Excl02<a name=\"ndhm-claim-exclusion-Excl02\"> </a></td><td>Specified disease/procedure waiting period</td></tr><tr><td style=\"white-space:nowrap\">Excl03<a name=\"ndhm-claim-exclusion-Excl03\"> </a></td><td>30-day waiting period</td></tr><tr><td style=\"white-space:nowrap\">Excl04<a name=\"ndhm-claim-exclusion-Excl04\"> </a></td><td>Investigation Evaluation</td></tr><tr><td style=\"white-space:nowrap\">Excl05<a name=\"ndhm-claim-exclusion-Excl05\"> </a></td><td>Rest Cure,Rehabilitation and Respite Care</td></tr><tr><td style=\"white-space:nowrap\">Excl06<a name=\"ndhm-claim-exclusion-Excl06\"> </a></td><td>Obesity/Weight Control</td></tr><tr><td style=\"white-space:nowrap\">Excl07<a name=\"ndhm-claim-exclusion-Excl07\"> </a></td><td>Change-of-Gender treatments</td></tr><tr><td style=\"white-space:nowrap\">Excl08<a name=\"ndhm-claim-exclusion-Excl08\"> </a></td><td>Cosmetic or plastic Surgery</td></tr><tr><td style=\"white-space:nowrap\">Excl09<a name=\"ndhm-claim-exclusion-Excl09\"> </a></td><td>Hazardous or Adventure sports</td></tr><tr><td style=\"white-space:nowrap\">Excl10<a name=\"ndhm-claim-exclusion-Excl10\"> </a></td><td>Breach of law</td></tr><tr><td style=\"white-space:nowrap\">Excl11<a name=\"ndhm-claim-exclusion-Excl11\"> </a></td><td>Excluded Providers</td></tr><tr><td style=\"white-space:nowrap\">Excl12<a name=\"ndhm-claim-exclusion-Excl12\"> </a></td><td>Rehabilitation</td></tr><tr><td style=\"white-space:nowrap\">Excl13<a name=\"ndhm-claim-exclusion-Excl13\"> </a></td><td>Hydrotherapy</td></tr><tr><td style=\"white-space:nowrap\">Excl14<a name=\"ndhm-claim-exclusion-Excl14\"> </a></td><td>Non-prescription</td></tr><tr><td style=\"white-space:nowrap\">Excl15<a name=\"ndhm-claim-exclusion-Excl15\"> </a></td><td>Refractive Error</td></tr><tr><td style=\"white-space:nowrap\">Excl16<a name=\"ndhm-claim-exclusion-Excl16\"> </a></td><td>Unproven Treatments</td></tr><tr><td style=\"white-space:nowrap\">Excl17<a name=\"ndhm-claim-exclusion-Excl17\"> </a></td><td>Sterility and Infertility</td></tr><tr><td style=\"white-space:nowrap\">Excl18<a name=\"ndhm-claim-exclusion-Excl18\"> </a></td><td>Maternity Expenses</td></tr><tr><td style=\"white-space:nowrap\">IIB13<a name=\"ndhm-claim-exclusion-IIB13\"> </a></td><td>Fraudulent Claim</td></tr><tr><td style=\"white-space:nowrap\">IIB14<a name=\"ndhm-claim-exclusion-IIB14\"> </a></td><td>Sum insured exhausted</td></tr><tr><td style=\"white-space:nowrap\">IIB15<a name=\"ndhm-claim-exclusion-IIB15\"> </a></td><td>Withdrawal by the Insured</td></tr><tr><td style=\"white-space:nowrap\">IIB16<a name=\"ndhm-claim-exclusion-IIB16\"> </a></td><td>Suppression of Material Information</td></tr><tr><td style=\"white-space:nowrap\">IIB17<a name=\"ndhm-claim-exclusion-IIB17\"> </a></td><td>Waiting Period beyond 30 days</td></tr><tr><td style=\"white-space:nowrap\">IIB20<a name=\"ndhm-claim-exclusion-IIB20\"> </a></td><td>Not covered under the Terms and Conditions of the contract</td></tr></table></div>"
},
"url" : "https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusion",
"version" : "6.5.0",
"name" : "ClaimExclusion",
"title" : "Claim Exclusion",
"status" : "draft",
"experimental" : false,
"date" : "2023-07-05",
"publisher" : "National Resource Center for EHR Standards",
"contact" : [
{
"name" : "National Resource Center for EHR Standards",
"telecom" : [
{
"system" : "url",
"value" : "https://nrces.in/"
}
]
}
],
"description" : "This CodeSystem comprises codes that describes excluded coverage within a health insurance product.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "IN",
"display" : "India"
}
]
}
],
"caseSensitive" : true,
"content" : "complete",
"count" : 24,
"concept" : [
{
"code" : "Excl01",
"display" : "Pre-Existing Diseases"
},
{
"code" : "Excl02",
"display" : "Specified disease/procedure waiting period"
},
{
"code" : "Excl03",
"display" : "30-day waiting period"
},
{
"code" : "Excl04",
"display" : "Investigation Evaluation"
},
{
"code" : "Excl05",
"display" : "Rest Cure,Rehabilitation and Respite Care"
},
{
"code" : "Excl06",
"display" : "Obesity/Weight Control"
},
{
"code" : "Excl07",
"display" : "Change-of-Gender treatments"
},
{
"code" : "Excl08",
"display" : "Cosmetic or plastic Surgery"
},
{
"code" : "Excl09",
"display" : "Hazardous or Adventure sports"
},
{
"code" : "Excl10",
"display" : "Breach of law"
},
{
"code" : "Excl11",
"display" : "Excluded Providers"
},
{
"code" : "Excl12",
"display" : "Rehabilitation"
},
{
"code" : "Excl13",
"display" : "Hydrotherapy"
},
{
"code" : "Excl14",
"display" : "Non-prescription"
},
{
"code" : "Excl15",
"display" : "Refractive Error"
},
{
"code" : "Excl16",
"display" : "Unproven Treatments"
},
{
"code" : "Excl17",
"display" : "Sterility and Infertility"
},
{
"code" : "Excl18",
"display" : "Maternity Expenses"
},
{
"code" : "IIB13",
"display" : "Fraudulent Claim"
},
{
"code" : "IIB14",
"display" : "Sum insured exhausted"
},
{
"code" : "IIB15",
"display" : "Withdrawal by the Insured"
},
{
"code" : "IIB16",
"display" : "Suppression of Material Information"
},
{
"code" : "IIB17",
"display" : "Waiting Period beyond 30 days"
},
{
"code" : "IIB20",
"display" : "Not covered under the Terms and Conditions of the contract"
}
]
}