FHIR Implementation Guide for ABDM
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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

ValueSet: Claim Exclusion

Official URL: https://nrces.in/ndhm/fhir/r4/ValueSet/ndhm-claim-exclusion Version: 6.5.0
Draft as of 2023-07-20 Computable Name: ClaimExclusion

This ValueSet comprises codes that describes excluded coverage within a health insurance product.

References

Logical Definition (CLD)

Generated Narrative: ValueSet ndhm-claim-exclusion

 

Expansion

Generated Narrative: ValueSet

Expansion done internally based on codesystem Claim Exclusion v6.5.0 (CodeSystem)

This value set contains 24 concepts

CodeSystemDisplay
  Excl01https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionPre-Existing Diseases
  Excl02https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionSpecified disease/procedure waiting period
  Excl03https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusion30-day waiting period
  Excl04https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionInvestigation Evaluation
  Excl05https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionRest Cure,Rehabilitation and Respite Care
  Excl06https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionObesity/Weight Control
  Excl07https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionChange-of-Gender treatments
  Excl08https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionCosmetic or plastic Surgery
  Excl09https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionHazardous or Adventure sports
  Excl10https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionBreach of law
  Excl11https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionExcluded Providers
  Excl12https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionRehabilitation
  Excl13https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionHydrotherapy
  Excl14https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionNon-prescription
  Excl15https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionRefractive Error
  Excl16https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionUnproven Treatments
  Excl17https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionSterility and Infertility
  Excl18https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionMaternity Expenses
  IIB13https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionFraudulent Claim
  IIB14https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionSum insured exhausted
  IIB15https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionWithdrawal by the Insured
  IIB16https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionSuppression of Material Information
  IIB17https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionWaiting Period beyond 30 days
  IIB20https://nrces.in/ndhm/fhir/r4/CodeSystem/ndhm-claim-exclusionNot covered under the Terms and Conditions of the contract

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code