Da Vinci - Coverage Requirements Discovery
2.0.1 - STU 2 United States of America flag

Da Vinci - Coverage Requirements Discovery, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. 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: 2.0.1
Standards status: Trial-use Maturity Level: 2 Computable Name: CRDCardType

List of card types defined by the CRD spec

References

Logical Definition (CLD)

 

Expansion

Expansion based on codesystem CRD Temporary Codes v2.0.1 (CodeSystem)

This value set contains 14 concepts.

CodeSystemDisplayDefinition
  coverage-infohttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempCoverage Information

Information related to the patient's coverage, including whether a service is covered, requires prior authorization, is approved without seeking prior authorization, and/or requires additional documentation or data collection

  claimhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempClaim

Information about what steps need to be taken to submit a claim for the service

  insurancehttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempInsurance

Allows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)

  limitshttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempLimits

Messages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general

  networkhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempNetwork

Providing information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)

  appropriate-usehttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempAppropriate Use

Guidance on whether appropriate-use documentation is needed

  costhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempCost

What is the anticipated cost to the patient based on their coverage

  therapy-alternatives-opthttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempOptional Therapy Alternatives

Are there alternative therapies that have better coverage and/or are lower-cost for the patient

  therapy-alternatives-reqhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempRequired Therapy Alternatives

Are there alternative therapies that must be tried first prior to coverage being available for the proposed therapy

  clinical-reminderhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempClinical Reminder

Reminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)

  duplicate-therapyhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempDuplicate Therapy

Notice that the proposed intervention has already recently occurred with a different provider when that information isn't already available in the provider system

  contraindicationhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempContraindication

Notice that the proposed intervention may be contraindicated based on information the payer has in their record that the provider doesn't have in theirs

  guidelinehttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempGuideline

Indication that there is a guideline available for the proposed therapy (with an option to view)

  off-guidelinehttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempOff Guideline

Notice 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