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

Artifact List

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide

Appointment

This profile specifies extensions and constraints on the Appointment resource to support coverage requirements discovery.

ClaimResponse

This profile specifies constraints on ClaimResponse resource to reflect the contents of a pro-active prior authorization returned via a card

CommunicationRequest

This profile specifies constraints on the CommunicationRequest resource to support coverage requirements discovery.

Coverage

This profile specifies constraints on the Coverage resource to support coverage requirements discovery.

CoverageDeident

This profile specifies constraints on the Coverage resource to identify coverage plan type without exposing patient identity during coverage requirements discovery.

CRDCardTask

This profile specifies constraints on the Task resource to support the creation of deferred task.

Device

This profile specifies additional constraints on the US Core Device Profile to support coverage requirements discovery.

DeviceRequest

This profile specifies extensions and constraints on the DeviceRequest resource to support coverage requirements discovery.

Encounter

This profile specifies additional extensions and constraints on the US Core Encounter profile to support coverage requirements discovery.

Location

This profile specifies constraints on the US Core Location profile to support coverage requirements discovery.

MedicationRequest

This profile specifies additional constraints on the US Core MedicationRequest profile to support coverage requirements discovery.

NutritionOrder

This profile specifies extensions and constraints on the NutritionOrder resource to support coverage requirements discovery.

Organization

This profile specifies additional constraints on the US Core Organization profile to support coverage requirements discovery.

Patient

This profile specifies additional constraints on the US Core Patient profile to support coverage requirements discovery.

PatientDident

This profile specifies additional constraints on the US Core Patient profile to support coverage requirements discovery without revealing patient identity.

Practitioner

This profile specifies constraints on the Practitioner resource to support coverage requirements discovery.

ServiceRequest

This profile specifies constraints on the ServiceRequest resource to support coverage requirements discovery.

TaskQuestionnaire

This profile specifies constraints on the Task resource to support requests for form (Questionnaire) completion.

Structures: Extension Definitions

These define constraints on FHIR data types for systems conforming to this implementation guide

Coverage Information

Captures assertions from a payer about whether the service is covered and/or requires prior authorization.

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide

CRD Card Types Value Set

List of card types

CRD Service Request Codes

Example value set defines a set CPT, SNOMED CT, HCPCS Level II and LOINC codes mirroring bindings found in the US Core Procedure and Observation Lab profiles.

CRD Reason Codes

Reasons for creating tasks in CRD

CRD After Completion Code

Actions to take after completing form

CRD Location Address Types

Address codes allowed for CRD locations - those that are physical addresses

CRD Coverage Classes

Restriction of coverage classes for CRD purposes

CDS Hooks Card Suggestion Action Types

Codes allowed for defining the type of action in a CDS Hooks suggestion

Coverage Guidance Value Set

Coverage guidance

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide

Coverage Guidance Code System

Coverage guidance

CRD Card Types Code System

List of card types

CRD Temporary Codes

Codes temporarily defined as part of the CRD implementation guide. These will eventually migrate into an officially maintained terminology (likely either SNOMED CT or HL7’s UTG code systems).

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like

Appointment example

Example appointment populated based on CRD profile

Prior Authorization example

Example prior authorization populated based on CRD profile

CommunicationRequest example

Example communication request populated based on CRD profile

De-identified Coverage example

Example de-identified coverage populated based on CRD profile

Coverage example

Example identified coverage populated based on CRD profile

Device example

Example device populated based on CRD profile

DeviceRequest example

Example devicerequest populated based on CRD profile

Encounter example

Example encounter populated based on CRD profile

Location example

Example location populated based on CRD profile

MedicationRequest example

Example medication request populated based on CRD profile

MedicationRequest annotated example

Example medication request with an annotation showing coverage expectations

NutritionOder example

Example nutrition order populated based on CRD profile

Organization example

Example organization populated based on CRD profile

De-identified Patient example

Example de-identified patient populated based on CRD profile

Patient example

Example patient populated based on CRD profile

Practitioner example

Example practitioner populated based on CRD profile

ServiceRequest example

Example service request populated based on CRD profile

Questionnaire Task example

Example questionnaire-completion Task populated based on CRD profile

CDS Hook deferred action example

Example Task showing a deferred action to update a Coverage record for a patient