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="crd-coverage-detail"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem crd-coverage-detail</b></p><a name="crd-coverage-detail"> </a><a name="hccrd-coverage-detail"> </a><p><b>Properties</b></p><p><b>This code system defines the following properties for its concepts</b></p><table class="grid"><tr><td><b>Name</b></td><td><b>Code</b></td><td><b>URI</b></td><td><b>Type</b></td></tr><tr><td>Not Selectable</td><td>abstract</td><td>http://hl7.org/fhir/concept-properties#notSelectable</td><td>boolean</td></tr></table><p><b>Concepts</b></p><p>This case-sensitive code system <code>http://terminology.hl7.org/CodeSystem/crd-coverage-detail</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><td><b>Not Selectable</b></td></tr><tr><td>1</td><td style="white-space:nowrap">_limitation<a name="crd-coverage-detail-_limitation"> </a></td><td>Limitation details</td><td>Identifies detail codes that define limitations of coverage. (Category should be 'cat-limitation')</td><td>true</td></tr><tr><td>2</td><td style="white-space:nowrap"> allowed-quantity<a name="crd-coverage-detail-allowed-quantity"> </a></td><td>Maximum quantity</td><td>Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity</td><td/></tr><tr><td>2</td><td style="white-space:nowrap"> allowed-period<a name="crd-coverage-detail-allowed-period"> </a></td><td>Maximum allowed period</td><td>Indicates the maximum period of time that can be covered in a single order. Value should be a Period</td><td/></tr><tr><td>1</td><td style="white-space:nowrap">_decisional<a name="crd-coverage-detail-_decisional"> </a></td><td>Decisional details</td><td>Identifies detail codes that may impact patient and clinician decision making (Category should be 'cat-decisional')</td><td>true</td></tr><tr><td>2</td><td style="white-space:nowrap"> in-network-copay<a name="crd-coverage-detail-in-network-copay"> </a></td><td>Copay for in-network</td><td>Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity.</td><td/></tr><tr><td>2</td><td style="white-space:nowrap"> out-network-copay<a name="crd-coverage-detail-out-network-copay"> </a></td><td>Copay for out-of-network</td><td>Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity.</td><td/></tr><tr><td>2</td><td style="white-space:nowrap"> concurrent-review<a name="crd-coverage-detail-concurrent-review"> </a></td><td>Concurrent review</td><td>Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean.</td><td/></tr><tr><td>2</td><td style="white-space:nowrap"> appropriate-use-needed<a name="crd-coverage-detail-appropriate-use-needed"> </a></td><td>Appropriate use</td><td>Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean.</td><td/></tr><tr><td>1</td><td style="white-space:nowrap">_other<a name="crd-coverage-detail-_other"> </a></td><td>Other details</td><td>Identifies detail codes that are generally not relevant to clinicians/patients (Category should be 'cat-other')</td><td>true</td></tr><tr><td>2</td><td style="white-space:nowrap"> policy-link<a name="crd-coverage-detail-policy-link"> </a></td><td>Policy Link</td><td>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.</td><td/></tr><tr><td>1</td><td style="white-space:nowrap">instructions<a name="crd-coverage-detail-instructions"> </a></td><td>Instructions</td><td>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.)</td><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/crd-coverage-detail"/>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:oid:2.16.840.1.113883.5.177"/>
</identifier>
<version value="1.0.0"/>
<name value="CRDCoverageDetail"/>
<title value="CRD Coverage Detail Codes"/>
<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 that describe additional details related to a coverage information assertion. These live in THO rather than the CRD specification to support adding additional concepts without putting out a new CRD release."/>
<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"/>
<property>
<code value="abstract"/>
<uri value="http://hl7.org/fhir/concept-properties#notSelectable"/>
<type value="boolean"/>
</property>
<concept>
<code value="_limitation"/>
<display value="Limitation details"/>
<definition
value="Identifies detail codes that define limitations of coverage. (Category should be 'cat-limitation')"/>
<property>
<code value="abstract"/>
<valueBoolean value="true"/>
</property>
<concept>
<code value="allowed-quantity"/>
<display value="Maximum quantity"/>
<definition
value="Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity"/>
</concept>
<concept>
<code value="allowed-period"/>
<display value="Maximum allowed period"/>
<definition
value="Indicates the maximum period of time that can be covered in a single order. Value should be a Period"/>
</concept>
</concept>
<concept>
<code value="_decisional"/>
<display value="Decisional details"/>
<definition
value="Identifies detail codes that may impact patient and clinician decision making (Category should be 'cat-decisional')"/>
<property>
<code value="abstract"/>
<valueBoolean value="true"/>
</property>
<concept>
<code value="in-network-copay"/>
<display value="Copay for in-network"/>
<definition
value="Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity."/>
</concept>
<concept>
<code value="out-network-copay"/>
<display value="Copay for out-of-network"/>
<definition
value="Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity."/>
</concept>
<concept>
<code value="concurrent-review"/>
<display value="Concurrent review"/>
<definition
value="Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean."/>
</concept>
<concept>
<code value="appropriate-use-needed"/>
<display value="Appropriate use"/>
<definition
value="Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean."/>
</concept>
</concept>
<concept>
<code value="_other"/>
<display value="Other details"/>
<definition
value="Identifies detail codes that are generally not relevant to clinicians/patients (Category should be 'cat-other')"/>
<property>
<code value="abstract"/>
<valueBoolean value="true"/>
</property>
<concept>
<code value="policy-link"/>
<display value="Policy Link"/>
<definition
value="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."/>
</concept>
</concept>
<concept>
<code value="instructions"/>
<display value="Instructions"/>
<definition
value="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.)"/>
</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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