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 Information Needed Value Set

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

Codes defining whether information about the perfomer, location, and/or performance date is needed to determine coverage information

References

Logical Definition (CLD)

This value set includes codes based on the following rules:

  • Include these codes as defined in http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp
    CodeDisplayDefinition
    performerPerformer NeededInformation about who (specifically, or at least performer type and affiliation) is necessary to make a determination of coverage and/or prior auth expectations
    locationLocation NeededInformation about where (specific clinic/site or organization) is necessary to make a determination of coverage and/or prior auth expectations
    timeframeTimeframe NeededInformation about when the service will be performed that is more granular than the order effective period is necessary to make a determination of coverage and/or prior auth expectations
    contract-windowNew Contract WindowThe target performance time for the event falls outside the contract window for the patient's current coverage. Information will not be available until a contract is in place covering the service time period
  • Include these codes as defined in http://terminology.hl7.org/CodeSystem/v3-NullFlavor
    CodeDisplayDefinition
    OTH other **Description:**The actual value is not a member of the set of permitted data values in the constrained value domain of a variable. (e.g., concept not provided by required code system).

    **Usage Notes**: This flavor and its specializations are most commonly used with the CD datatype and its flavors. However, it may apply to \*any\* datatype where the constraints of the type are tighter than can be conveyed. For example, a PQ that is for a true measured amount whose units are not supported in UCUM, a need to convey a REAL when the type has been constrained to INT, etc.

    With coded datatypes, this null flavor may only be used if the vocabulary binding has a coding strength of CNE. By definition, all local codes and original text are part of the value set if the coding strength is CWE.

 

Expansion

This value set contains 5 concepts.

CodeSystemDisplayDefinition
  performerhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempPerformer Needed

Information about who (specifically, or at least performer type and affiliation) is necessary to make a determination of coverage and/or prior auth expectations

  locationhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempLocation Needed

Information about where (specific clinic/site or organization) is necessary to make a determination of coverage and/or prior auth expectations

  timeframehttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempTimeframe Needed

Information about when the service will be performed that is more granular than the order effective period is necessary to make a determination of coverage and/or prior auth expectations

  contract-windowhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempNew Contract Window

The target performance time for the event falls outside the contract window for the patient's current coverage. Information will not be available until a contract is in place covering the service time period

  OTHhttp://terminology.hl7.org/CodeSystem/v3-NullFlavorother

**Description:**The actual value is not a member of the set of permitted data values in the constrained value domain of a variable. (e.g., concept not provided by required code system).

Usage Notes: This flavor and its specializations are most commonly used with the CD datatype and its flavors. However, it may apply to *any* datatype where the constraints of the type are tighter than can be conveyed. For example, a PQ that is for a true measured amount whose units are not supported in UCUM, a need to convey a REAL when the type has been constrained to INT, etc.

With coded datatypes, this null flavor may only be used if the vocabulary binding has a coding strength of CNE. By definition, all local codes and original text are part of the value set if the coding strength is CWE.

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