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

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: Claim Exclusion - XML Representation

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="ndhm-claim-exclusion"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <url value="https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusion"/>
  <version value="6.5.0"/>
  <name value="ClaimExclusion"/>
  <title value="Claim Exclusion"/>
  <status value="draft"/>
  <experimental value="false"/>
  <date value="2023-07-05"/>
  <publisher value="National Resource Center for EHR Standards"/>
  <contact>
    <name value="National Resource Center for EHR Standards"/>
    <telecom>
      <system value="url"/>
      <value value="https://nrces.in/"/>
    </telecom>
  </contact>
  <description
               value="This CodeSystem comprises codes that describes excluded coverage within a health insurance product."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="IN"/>
      <display value="India"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="24"/>
  <concept>
    <code value="Excl01"/>
    <display value="Pre-Existing Diseases"/>
  </concept>
  <concept>
    <code value="Excl02"/>
    <display value="Specified disease/procedure waiting period"/>
  </concept>
  <concept>
    <code value="Excl03"/>
    <display value="30-day waiting period"/>
  </concept>
  <concept>
    <code value="Excl04"/>
    <display value="Investigation Evaluation"/>
  </concept>
  <concept>
    <code value="Excl05"/>
    <display value="Rest Cure,Rehabilitation and Respite Care"/>
  </concept>
  <concept>
    <code value="Excl06"/>
    <display value="Obesity/Weight Control"/>
  </concept>
  <concept>
    <code value="Excl07"/>
    <display value="Change-of-Gender treatments"/>
  </concept>
  <concept>
    <code value="Excl08"/>
    <display value="Cosmetic or plastic Surgery"/>
  </concept>
  <concept>
    <code value="Excl09"/>
    <display value="Hazardous or Adventure sports"/>
  </concept>
  <concept>
    <code value="Excl10"/>
    <display value="Breach of law"/>
  </concept>
  <concept>
    <code value="Excl11"/>
    <display value="Excluded Providers"/>
  </concept>
  <concept>
    <code value="Excl12"/>
    <display value="Rehabilitation"/>
  </concept>
  <concept>
    <code value="Excl13"/>
    <display value="Hydrotherapy"/>
  </concept>
  <concept>
    <code value="Excl14"/>
    <display value="Non-prescription"/>
  </concept>
  <concept>
    <code value="Excl15"/>
    <display value="Refractive Error"/>
  </concept>
  <concept>
    <code value="Excl16"/>
    <display value="Unproven Treatments"/>
  </concept>
  <concept>
    <code value="Excl17"/>
    <display value="Sterility and Infertility"/>
  </concept>
  <concept>
    <code value="Excl18"/>
    <display value="Maternity Expenses"/>
  </concept>
  <concept>
    <code value="IIB13"/>
    <display value="Fraudulent Claim"/>
  </concept>
  <concept>
    <code value="IIB14"/>
    <display value="Sum insured exhausted"/>
  </concept>
  <concept>
    <code value="IIB15"/>
    <display value="Withdrawal by the Insured"/>
  </concept>
  <concept>
    <code value="IIB16"/>
    <display value="Suppression of Material Information"/>
  </concept>
  <concept>
    <code value="IIB17"/>
    <display value="Waiting Period beyond 30 days"/>
  </concept>
  <concept>
    <code value="IIB20"/>
    <display
             value="Not covered under the Terms and Conditions of the contract"/>
  </concept>
</CodeSystem>