Da Vinci - Coverage Requirements Discovery
2.1.0-preview - 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 2.1.0-preview 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 Coverage Information Prior Authorization Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/coveragePaDetail Version: 2.1.0-preview
Standards status: Trial-use Maturity Level: 1 Computable Name: CRDCoveragePaDetail

Codes defining whether prior auth will be needed for coverage to be provided

References

Logical Definition (CLD)

  • Include these codes as defined in http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp
    CodeDisplayDefinition
    no-authNo Prior AuthorizationThe ordered service does not require prior authorization
    auth-neededPrior Authorization NeededThe ordered service will require prior authorization
    satisfiedAuthorization SatisfiedWhile prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed
    performpaPerformer Prior AuthorizationPrior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider.
    conditionalConditionalDecision cannot be made without more information (more detailed code, service rendering information, etc.)

 

Expansion

Expansion based on codesystem CRD Temporary Codes v2.1.0-preview (CodeSystem)

This value set contains 5 concepts.

CodeSystemDisplayDefinition
  no-authhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempNo Prior Authorization

The ordered service does not require prior authorization

  auth-neededhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempPrior Authorization Needed

The ordered service will require prior authorization

  satisfiedhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempAuthorization Satisfied

While prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed

  performpahttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempPerformer Prior Authorization

Prior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider.

  conditionalhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempConditional

Decision cannot be made without more information (more detailed code, service rendering information, etc.)

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