Da Vinci - Coverage Requirements Discovery
1.1.0-ballot - STU 1.1 United States of America flag

Da Vinci - Coverage Requirements Discovery, published by HL7 International - Financial Management Work Group. This is not an authorized publication; it is the continuous build for version 1.1.0-ballot). This version is based on the current content of https://github.com/HL7/davinci-crd/ and changes regularly. See the Directory of published versions

ValueSet: CRD Card Types Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/cardType Version: 1.1.0-ballot
Draft as of 2022-02-17 Computable Name: CardType

List of card types

References

This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

Logical Definition (CLD)

 

Expansion

This value set contains 18 concepts

Expansion based on CRD Card Types Code System v1.1.0-ballot (CodeSystem)

All codes in this table are from the system http://hl7.org/fhir/us/davinci-crd/CodeSystem/cardType

CodeDisplayDefinition
coverageCoverageIs the therapy covered or not, or are there limitations
documentationDocumentationAre there additional documentation requirements
prior-authPrior AuthorizationIs prior authorization required or not (and possibly provision of unsolicited prior authorizations)
dtr-clinDTR ClinIndication that DTR is relevant for prior authorization, claim or other documentation requirements and that at least some clinical information needs to be captured
dtr-adminDTR AdminIndication that DTR is relevant for prior authorization, claim or other documentation requirements and that all information to be captured is strictly administrative (and thus it is not necessary that the app be launched by the ordering clinician)
claimClaimInformation about what steps need to be taken to submit a claim for the service
insuranceInsuranceAllows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)
limitsLimitsMessages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general
networkNetworkProviding information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)
appropriate-useAppropriate UseGuidance on whether appropriate-use documentation is needed
costCostWhat is the anticipated cost to the patient based on their coverage
therapy-alternatives-optTherapy Alternatives OptAre there alternative therapies that have better coverage and/or are lower-cost for the patient
therapy-alternatives-reqTherapy Alternatives ReqAre there alternative therapies that must be tried first prior to coverage being available for the proposed therapy
clinical-reminderClinical ReminderReminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)
duplicate-therapyDuplicate TherapyNotice that the proposed intervention has already recently occurred with a different provider when that information isn't already available in the provider system
contraindicationContraindicationNotice that the proposed intervention may be contraindicated based on information the payer has in their record that the provider doesn't have in theirs
guidelineGuidelineIndication that there is a guideline available for the proposed therapy (with an option to view)
off-guidelineOff GuidelineNotice that the proposed therapy may be contrary to best-practice guidelines, typically with an option to view the relevant guideline

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