HL7 Terminology (THO)
7.0.0 - Continuous Process Integration (ci build)
HL7 Terminology (THO)
7.0.0 - Continuous Process Integration (ci build)
HL7 Terminology (THO), published by HL7 International - Vocabulary Work Group. This guide is not an authorized publication; it is the continuous build for version 7.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/UTG/ and changes regularly. See the Directory of published versions
| Active as of 2025-10-16 | Maturity Level: 1 |
<CodeSystem xmlns="http://hl7.org/fhir">
<id value="cdshooks-card-type"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem cdshooks-card-type</b></p><a name="cdshooks-card-type"> </a><a name="hccdshooks-card-type"> </a><p>This case-sensitive code system <code>http://terminology.hl7.org/CodeSystem/cdshooks-card-type</code> defines the following codes in a Is-A hierarchy:</p><table class="codes"><tr><td><b>Lvl</b></td><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td>1</td><td style="white-space:nowrap">coverage-info<a name="cdshooks-card-type-coverage-info"> </a></td><td>Coverage Information</td><td>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</td></tr><tr><td>2</td><td style="white-space:nowrap"> unsolicited-determ<a name="cdshooks-card-type-unsolicited-determ"> </a></td><td>Unsolicited Determination</td><td>An unsolicited approval of the service as having prior authorization requirements met without a formal submission of a prior authorization request</td></tr><tr><td>1</td><td style="white-space:nowrap">claim<a name="cdshooks-card-type-claim"> </a></td><td>Claim</td><td>Information about what steps need to be taken to submit a claim for the service</td></tr><tr><td>1</td><td style="white-space:nowrap">insurance<a name="cdshooks-card-type-insurance"> </a></td><td>Insurance</td><td>Allows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)</td></tr><tr><td>1</td><td style="white-space:nowrap">limits<a name="cdshooks-card-type-limits"> </a></td><td>Limits</td><td>Messages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general</td></tr><tr><td>1</td><td style="white-space:nowrap">network<a name="cdshooks-card-type-network"> </a></td><td>Network</td><td>Providing information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)</td></tr><tr><td>1</td><td style="white-space:nowrap">appropriate-use<a name="cdshooks-card-type-appropriate-use"> </a></td><td>Appropriate Use</td><td>Guidance on whether appropriate-use documentation is needed</td></tr><tr><td>1</td><td style="white-space:nowrap">cost<a name="cdshooks-card-type-cost"> </a></td><td>Cost</td><td>What is the anticipated cost to the patient based on their coverage</td></tr><tr><td>1</td><td style="white-space:nowrap">therapy-alternatives-opt<a name="cdshooks-card-type-therapy-alternatives-opt"> </a></td><td>Optional Therapy Alternatives</td><td>Are there alternative therapies that have better coverage and/or are lower-cost for the patient</td></tr><tr><td>1</td><td style="white-space:nowrap">therapy-alternatives-req<a name="cdshooks-card-type-therapy-alternatives-req"> </a></td><td>Required Therapy Alternatives</td><td>Are there alternative therapies that must be tried first prior to coverage being available for the proposed therapy</td></tr><tr><td>1</td><td style="white-space:nowrap">clinical-reminder<a name="cdshooks-card-type-clinical-reminder"> </a></td><td>Clinical Reminder</td><td>Reminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)</td></tr><tr><td>1</td><td style="white-space:nowrap">duplicate-therapy<a name="cdshooks-card-type-duplicate-therapy"> </a></td><td>Duplicate Therapy</td><td>Notice that the proposed intervention has already recently occurred with a different provider when that information isn't already available in the provider system</td></tr><tr><td>1</td><td style="white-space:nowrap">contraindication<a name="cdshooks-card-type-contraindication"> </a></td><td>Contraindication</td><td>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</td></tr><tr><td>1</td><td style="white-space:nowrap">guideline<a name="cdshooks-card-type-guideline"> </a></td><td>Guideline</td><td>Indication that there is a guideline available for the proposed therapy (with an option to view)</td></tr><tr><td>1</td><td style="white-space:nowrap">off-guideline<a name="cdshooks-card-type-off-guideline"> </a></td><td>Off Guideline</td><td>Notice that the proposed therapy may be contrary to best-practice guidelines, typically with an option to view the relevant guideline</td></tr></table></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="fm"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
<valueInteger value="1"/>
</extension>
<url value="http://terminology.hl7.org/CodeSystem/cdshooks-card-type"/>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:oid:2.16.840.1.113883.5.176"/>
</identifier>
<version value="1.0.0"/>
<name value="CDSHooksCardType"/>
<title value="CDS Hooks Card Types"/>
<status value="active"/>
<experimental value="false"/>
<date value="2025-10-16T00:00:00+00:00"/>
<publisher value="Health Level Seven International"/>
<contact>
<telecom>
<system value="url"/>
<value value="http://hl7.org"/>
</telecom>
<telecom>
<system value="email"/>
<value value="hq@HL7.org"/>
</telecom>
</contact>
<description
value="Codes defining types of cards that can potentially be returned by a decision support service. The initial set of codes is biased towards those related to insurance coverage, but all types of response types are acceptable in the code system."/>
<copyright
value="This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license"/>
<caseSensitive value="true"/>
<hierarchyMeaning value="is-a"/>
<content value="complete"/>
<concept>
<code value="coverage-info"/>
<display value="Coverage Information"/>
<definition
value="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"/>
<concept>
<code value="unsolicited-determ"/>
<display value="Unsolicited Determination"/>
<definition
value="An unsolicited approval of the service as having prior authorization requirements met without a formal submission of a prior authorization request"/>
</concept>
</concept>
<concept>
<code value="claim"/>
<display value="Claim"/>
<definition
value="Information about what steps need to be taken to submit a claim for the service"/>
</concept>
<concept>
<code value="insurance"/>
<display value="Insurance"/>
<definition
value="Allows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)"/>
</concept>
<concept>
<code value="limits"/>
<display value="Limits"/>
<definition
value="Messages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general"/>
</concept>
<concept>
<code value="network"/>
<display value="Network"/>
<definition
value="Providing information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)"/>
</concept>
<concept>
<code value="appropriate-use"/>
<display value="Appropriate Use"/>
<definition
value="Guidance on whether appropriate-use documentation is needed"/>
</concept>
<concept>
<code value="cost"/>
<display value="Cost"/>
<definition
value="What is the anticipated cost to the patient based on their coverage"/>
</concept>
<concept>
<code value="therapy-alternatives-opt"/>
<display value="Optional Therapy Alternatives"/>
<definition
value="Are there alternative therapies that have better coverage and/or are lower-cost for the patient"/>
</concept>
<concept>
<code value="therapy-alternatives-req"/>
<display value="Required Therapy Alternatives"/>
<definition
value="Are there alternative therapies that must be tried first prior to coverage being available for the proposed therapy"/>
</concept>
<concept>
<code value="clinical-reminder"/>
<display value="Clinical Reminder"/>
<definition
value="Reminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)"/>
</concept>
<concept>
<code value="duplicate-therapy"/>
<display value="Duplicate Therapy"/>
<definition
value="Notice that the proposed intervention has already recently occurred with a different provider when that information isn't already available in the provider system"/>
</concept>
<concept>
<code value="contraindication"/>
<display value="Contraindication"/>
<definition
value="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"/>
</concept>
<concept>
<code value="guideline"/>
<display value="Guideline"/>
<definition
value="Indication that there is a guideline available for the proposed therapy (with an option to view)"/>
</concept>
<concept>
<code value="off-guideline"/>
<display value="Off Guideline"/>
<definition
value="Notice that the proposed therapy may be contrary to best-practice guidelines, typically with an option to view the relevant guideline"/>
</concept>
</CodeSystem>
IG © 2020+ HL7 International - Vocabulary Work Group. Package hl7.terminology#7.0.0 based on FHIR 5.0.0. Generated 2025-11-26
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