CodeSystem: CRDTempCodes Id: temp Title: "CRD Temporary Codes" Description: "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)." * ^status = #active * ^experimental = false * ^caseSensitive = true * ^hierarchyMeaning = #is-a * ^content = #complete * ^property[0].code = #abstract * ^property[0].uri = "http://hl7.org/fhir/concept-properties#notSelectable" * ^property[0].type = #boolean // Coverage assertion reasons - https://jira.hl7.org/browse/UP-668 * #gold-card "Gold card" "Ordering Practitioner has been granted 'gold card' status with this payer/coverage type." * #no-member-found "Member not found" "The CRD server was unable to find a matching member, so no coverage information can be provided" * #no-active-coverage "Coverage not active" "The referenced insurance coverage for the member is not active, so no coverage information can be provided" * #auth-out-network "Authorization needed out-of-network" "Authorization is necessary if out-of-network." // Coverage detail types - https://jira.hl7.org/browse/UP-670 * #_limitation "Limitation details" "Identifies detail codes that define limitations of coverage. (Category should be 'cat-limitation')" * ^property.code = #abstract * ^property.valueBoolean = true * #allowed-quantity "Maximum quantity" "Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity" * #allowed-period "Maximum allowed period" "Indicates the maximum period of time that can be covered in a single order. Value should be a Period" * #_decisional "Decisional details" "Identifies detail codes that may impact patient and clinician decision making (Category should be 'cat-decisional')" * ^property.code = #abstract * ^property.valueBoolean = true * #in-network-copay "Copay for in-network" "Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity." * #out-network-copay "Copay for out-of-network" "Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity." * #concurrent-review "Concurrent review" "Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean." * #appropriate-use-needed "Appropriate use" "Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean." * #_other "Other details" "Identifies detail codes that are generally not relevant to clinicians/patients (Category should be 'cat-other')" * ^property.code = #abstract * ^property.valueBoolean = true * #policy-link "Policy Link" "A URL pointing to the specific portion of a payer policy, coverage agreement or similar authoritative document that provides a portion of the basis for the decision documented in the coverage-information. Value should be a url." * #instructions "Instructions" "Information to display to the user that gives guidance about what steps to take in achieving the recommended actions identified by this coverage-information (e.g. special instructions about requesting authorization, details about information needed, details about data retention, etc.). Value should be a string. (Category may vary.)" // Card types - https://jira.hl7.org/browse/UP-669 * #_cardType "Card Type (abstract)" "A collector for different profiles on CDS Hooks card" * ^property.code = #abstract * ^property.valueBoolean = true * #coverage-info "Coverage 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" * #unsolicited-determ "Unsolicited Determination" "An unsolicited approval of the service as having prior authorization requirements met without a formal submission of a prior authorization request" * #claim "Claim" "Information about what steps need to be taken to submit a claim for the service" * #insurance "Insurance" "Allows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)" * #limits "Limits" "Messages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general" * #network "Network" "Providing information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)" * #appropriate-use "Appropriate Use" "Guidance on whether appropriate-use documentation is needed" * #cost "Cost" "What is the anticipated cost to the patient based on their coverage" * #therapy-alternatives-opt "Optional Therapy Alternatives" "Are there alternative therapies that have better coverage and/or are lower-cost for the patient" * #therapy-alternatives-req "Required Therapy Alternatives" "Are there alternative therapies that must be tried first prior to coverage being available for the proposed therapy" * #clinical-reminder "Clinical Reminder" "Reminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)" * #duplicate-therapy "Duplicate Therapy" "Notice that the proposed intervention has already recently occurred with a different provider when that information is not already available in the provider system" * #contraindication "Contraindication" "Notice that the proposed intervention may be contraindicated based on information the payer has in their record that the provider does not have in theirs" * #guideline "Guideline" "Indication that there is a guideline available for the proposed therapy (with an option to view)" * #off-guideline "Off Guideline" "Notice that the proposed therapy may be contrary to best-practice guidelines, typically with an option to view the relevant guideline" * #_reqcat "Requirements Categories" "Codes that help to categorize requirements statements" * ^property.code = #abstract * ^property.valueBoolean = true * #business "business" "Requirements relating to the business operations of the entities responsible for a system" * #exchange "exchange" "Requirements relating to when or how data is exchanged with other systems" * #processing "processing" "Requirements related to how data is dealt with internally to a system" * #storage "storage" "Requirements relating to when or how data is or is not persisted within a system" * #ui "ui" "Requirements relating to the appearance of information on a user interface"