Da Vinci - Coverage Requirements Discovery
2.1.0 - STU 2.1
Da Vinci - Coverage Requirements Discovery
2.1.0 - STU 2.1
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 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
{
"hookInstance": "1372e258-5ae2-4dd3-b716-dd0b1e7a8728",
"fhirServer": "http://example.org/some-payer/fhir/crd",
"hook": "order-sign",
"fhirAuthorization": {
"access_token": "some-opaque-fhir-access-token",
"token_type": "Bearer",
"expires_in": 300,
"scope": "user/Patient.read user/Observation.read",
"subject": "cds-service4"
},
"context": {
"userId": "Practitioner/ABC",
"patientId": "123",
"encounterId": "987",
"draftOrders": {
"resourceType": "Bundle",
"type": "collection",
"entry": [
{
"fullUrl": "http://example.org/someEHR/fhir/MedicationRequest/1111",
"resource": {
"resourceType": "MedicationRequest",
"id": "1111",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Diclofenac potassium 50 MG Oral Tablet prescription for Amy V. Baxter by Dr. Jones, Feb 15, 2019<br/>1 50mg tablet, 3 times per day<br/>Dispense 90 tablets, 5 refills</div>"
},
"status": "draft",
"intent": "order",
"medicationReference": {
"reference": "http://example.org/someEHR/fhir/Patient/MED1"
},
"subject": {
"reference": "http://example.org/someEHR/fhir/Patient/123"
},
"encounter": {
"reference": "http://example.org/someEHR/fhir/Encounter/987"
},
"authoredOn": "2015-11-01",
"requester": {
"reference": "http://example.org/someEHR/fhir/PractitionerRole/ABC"
},
"dosageInstruction": [
{
"text": "1 50mg tablet, 3 times per day",
"timing": {
"repeat": {
"boundsPeriod": {
"start": "2015-11-01",
"end": "2016-05-01"
},
"frequency": 3,
"period": 1,
"periodUnit": "d"
}
},
"doseAndRate": [
{
"doseQuantity": {
"value": 1,
"unit": "Tablet",
"system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code": "TAB"
}
}
]
}
],
"dispenseRequest": {
"numberOfRepeatsAllowed": 5,
"quantity": {
"value": 90,
"unit": "Tablet",
"system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code": "TAB"
}
}
}
},
{
"fullUrl": "http://example.org/someEHR/fhir/MedicationRequest/2222",
"resource": {
"resourceType": "MedicationRequest",
"id": "2222",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Abuse-Deterrent 12 HR oxycodone hydrochloride 10 MG Extended Release Oral Tablet [Oxycontin] prescription for Amy V. Baxter by Dr. Jones, Feb 15, 2019<br/>1 10mg tablet, every 12 hours<br/>Dispense 28 tablets, 0 refills</div>"
},
"status": "draft",
"intent": "order",
"medicationReference": {
"reference": "http://example.org/someEHR/fhir/Patient/MED2"
},
"subject": {
"reference": "http://example.org/someEHR/fhir/Patient/123"
},
"encounter": {
"reference": "http://example.org/someEHR/fhir/Encounter/987"
},
"authoredOn": "2015-11-01",
"requester": {
"reference": "http://example.org/someEHR/fhir/PractitionerRole/ABC"
},
"dosageInstruction": [
{
"text": "1 10mg tablet, every 12 hours",
"timing": {
"repeat": {
"boundsPeriod": {
"start": "2015-11-01",
"end": "2015-11-15"
},
"frequency": 1,
"period": 12,
"periodUnit": "h"
}
},
"doseAndRate": [
{
"doseQuantity": {
"value": 1,
"unit": "Tablet",
"system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code": "TAB"
}
}
]
}
],
"dispenseRequest": {
"numberOfRepeatsAllowed": 0,
"quantity": {
"value": 28,
"unit": "Tablet",
"system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code": "TAB"
}
}
}
}
]
}
},
"prefetch": {
"patient": {
"resourceType": "Patient",
"id": "123",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\"><b>Amy V. Baxter </b> female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: USUAL))</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Record is active\">Active:</td><td colspan=\"3\">true</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Alternate names (see the one above)\">Alt. Name:</td><td colspan=\"3\">Amy V. Shaw (OLD)</td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Details:</td><td colspan=\"3\"><ul><li>ph: 555-555-5555(HOME)</li><li><a href=\"mailto:amy.shaw@example.com\">amy.shaw@example.com</a></li><li>49 MEADOW ST MOUNDS OK 74047 US (OLD)</li><li>183 MOUNTAIN VIEW ST MOUNDS OK 74048 US </li></ul></td></tr></table></div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex",
"valueCode": "F"
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-sex",
"valueCode": "248152002"
},
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-genderIdentity",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Unknown"
}
],
"text": "Unknown"
}
}
],
"identifier": [
{
"use": "usual",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR",
"display": "Medical Record Number"
}
],
"text": "Medical Record Number"
},
"system": "http://hospital.smarthealthit.org",
"value": "1032702"
}
],
"active": true,
"name": [
{
"use": "old",
"family": "Shaw",
"given": [
"Amy",
"V."
],
"period": {
"start": "2016-12-06",
"end": "2020-07-22"
}
},
{
"family": "Baxter",
"given": [
"Amy",
"V."
],
"suffix": [
"PharmD"
],
"period": {
"start": "2020-07-22"
}
}
],
"telecom": [
{
"system": "phone",
"value": "555-555-5555",
"use": "home"
},
{
"system": "email",
"value": "amy.shaw@example.com"
}
],
"gender": "female",
"birthDate": "1987-02-20",
"address": [
{
"use": "old",
"line": [
"49 MEADOW ST"
],
"city": "MOUNDS",
"state": "OK",
"postalCode": "74047",
"country": "US",
"period": {
"start": "2016-12-06",
"end": "2020-07-22"
}
},
{
"line": [
"183 MOUNTAIN VIEW ST"
],
"city": "MOUNDS",
"state": "OK",
"postalCode": "74048",
"country": "US",
"period": {
"start": "2020-07-22"
}
}
]
},
"encounter": {
"resourceType": "Encounter",
"id": "987",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: Encounter</b><a name=\"example-1\"> </a></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource Encounter "example-1" Updated "2017-05-26 11:56:57-0400" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-us-core-encounter.html\">US Core Encounter Profile (version 7.0.0-ballot)</a></p></div><p><b>status</b>: finished</p><p><b>class</b>: ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'ambulatory')</p><p><b>type</b>: Office Visit <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-CPT.html\">Current Procedural Terminology (CPT®)</a>#99211)</span></p><p><b>subject</b>: <a href=\"Patient-example.html\">Patient/example</a> " SHAW"</p><p><b>period</b>: 2015-11-01 17:00:14-0500 --> 2015-11-01 18:00:14-0500</p><h3>Locations</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Location</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Location-hospital.html\">Location/hospital: Holy Family Hospital</a> "Holy Family Hospital"</td></tr></table></div>"
},
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB",
"display": "ambulatory"
},
"type": [
{
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99211"
}
],
"text": "Office Visit"
}
],
"subject": {
"reference": "http://example.org/someEHR/fhir/Patient/123"
},
"period": {
"start": "2015-11-01T17:00:14-05:00",
"end": "2015-11-01T18:00:14-05:00"
},
"location": [
{
"location": {
"reference": "http://example.org/someEHR/fhir/Location/hospital",
"display": "Holy Family Hospital"
}
}
]
},
"coverage": {
"resourceType": "Bundle",
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "http://example.org/someEHR/fhir/r4/Coverage?patient=123&status=active"
}
],
"entry": [
{
"fullUrl": "http://example.org/someEHR/fhir/Coverage/COV1",
"resource": {
"resourceType": "Coverage",
"id": "COV1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>identifier</b>: Member Number:\u00a088800933501</p><p><b>status</b>: active</p><p><b>type</b>: PPO <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://nahdo.org/sopt\">Source of Payment Typology</a>#3712; <a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v3-ActCode.html\">ActCode</a>#PPO "preferred provider organization policy")</span></p><p><b>subscriberId</b>: 888009335</p><p><b>beneficiary</b>: <a href=\"Patient-example.html\">Patient/example</a> " SHAW"</p><p><b>relationship</b>: Self <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-subscriber-relationship.html\">SubscriberPolicyholder Relationship Codes</a>#self)</span></p><p><b>period</b>: 2020-01-01 --> (ongoing)</p><p><b>payor</b>: <a href=\"Organization-acme-payer.html\">Organization/acme-payer: Acme Health Plan</a> "Acme Health Plan"</p><blockquote><p><b>class</b></p><p><b>type</b>: An employee group <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#group "Group")</span></p><p><b>value</b>: xyz</p><p><b>name</b>: XYZ employee Group Plan</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: A specific suite of benefits. <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-coverage-class.html\">Coverage Class Codes</a>#plan "Plan")</span></p><p><b>value</b>: gold</p><p><b>name</b>: Acme Gold Plan</p></blockquote></div>"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MB",
"display": "Member Number"
}
]
},
"system": "http://example.org/fhir/memberidentifier",
"value": "88800933501"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "PPO",
"display": "preferred provider organization policy"
}
],
"text": "PPO"
},
"subscriberId": "888009335",
"beneficiary": {
"reference": "http://example.org/someEHR/fhir/Patient/123"
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self"
}
],
"text": "Self"
},
"period": {
"start": "2020-01-01"
},
"payor": [
{
"reference": "http://example.org/someEHR/fhir/Organization/acme-payer",
"display": "Acme Health Plan"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "group",
"display": "Group"
}
],
"text": "An employee group"
},
"value": "xyz",
"name": "XYZ employee Group Plan"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan",
"display": "Plan"
}
],
"text": "A specific suite of benefits."
},
"value": "gold",
"name": "Acme Gold Plan"
}
]
},
"search": {
"mode": "match"
}
}
]
},
"device": null,
"medication": {
"resourceType": "Bundle",
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "http://example.org/someEHR/fhir/r4/Medication?_id=MED1,MED2"
}
],
"entry": [
{
"fullUrl": "http://example.org/someEHR/fhir/Medication/MED1",
"resource": {
"resourceType": "Medication",
"id": "MED1",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>code</b>: Diclofenac Potassium (product)</p><p><b>status</b>: active</p></div>"
},
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/ndc",
"code": "0093-0948",
"display": "Diclofenac Potassium (product)"
}
]
},
"status": "active"
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "http://example.org/someEHR/fhir/Medication/MED2",
"resource": {
"resourceType": "Medication",
"id": "MED2",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>code</b>: OxyContin (product)</p><p><b>status</b>: active</p></div>"
},
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/ndc",
"code": "59011-410",
"display": "OxyContin (product)"
}
]
},
"status": "active"
},
"search": {
"mode": "match"
}
}
]
},
"practitioners": {
"resourceType": "Bundle",
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "http://example.org/someEHR/fhir/r4/Practitioner?_id=DEF"
}
],
"entry": [
{
"fullUrl": "http://example.org/someEHR/fhir/Practitioner/DEF",
"resource": {
"resourceType": "Practitioner",
"id": "DEF",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>identifier</b>: id:\u00a0<a href=\"http://terminology.hl7.org/5.3.0/NamingSystem-npi.html\">#</a>9941339100, id:\u00a025456</p><p><b>name</b>: Ronald Bone </p><p><b>address</b>: 1003 HEALTHCARE DR AMHERST MA 01002 (WORK)</p></div>"
},
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "9941339100"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction",
"valueCodeableConcept": {
"coding": [
{
"system": "https://www.usps.com/",
"code": "MA"
}
],
"text": "Massachusetts"
}
}
],
"system": "http://www.acme.org/practitioners",
"value": "25456"
}
],
"name": [
{
"family": "Bone",
"given": [
"Ronald"
],
"prefix": [
"Dr"
]
}
],
"address": [
{
"use": "work",
"line": [
"1003 HEALTHCARE DR"
],
"city": "AMHERST",
"state": "MA",
"postalCode": "01002"
}
]
},
"search": {
"mode": "match"
}
}
]
},
"practitionerRoles": {
"resourceType": "Bundle",
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "http://example.org/someEHR/fhir/r4/PractitionerRole?_id=ABC"
}
],
"entry": [
{
"fullUrl": "http://example.org/someEHR/fhir/PractitionerRole/ABC",
"resource": {
"resourceType": "PractitionerRole",
"id": "ABC",
"meta": {
"lastUpdated": "2016-02-29T23:52:32.387Z"
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Dr. Ronald Bone, primary care physician at Acme Clinic</div>"
},
"practitioner": {
"reference": "http://example.org/someEHR/fhir/Practitioner/DEF",
"display": "Dr. Ronald Bone"
},
"organization": {
"reference": "http://example.org/someEHR/fhir/Organization/GHI",
"display": "Acme Clinic"
},
"code": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationFunction",
"code": "PCP",
"display": "primary care physician"
},
{
"system": "http://nucc.org/provider-taxonomy",
"code": "261QP2300X",
"display": "Primary Care Clinic/Center"
}
]
}
]
},
"search": {
"mode": "match"
}
}
]
},
"organizations": {
"resourceType": "Bundle",
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "http://example.org/someEHR/fhir/r4/Organization?_id=GHI"
}
],
"entry": [
{
"fullUrl": "http://example.org/someEHR/fhir/Organization/GHI",
"resource": {
"resourceType": "Organization",
"id": "GHI",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>identifier</b>: id:\u00a0<a href=\"http://terminology.hl7.org/5.3.0/NamingSystem-npi.html\">#</a>1407071236, id:\u00a0121111111</p><p><b>active</b>: true</p><p><b>type</b>: Healthcare Provider <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-organization-type.html\">Organization type</a>#prov)</span></p><p><b>name</b>: Acme Clinic</p><p><b>telecom</b>: ph: (+1) 734-677-7777, <a href=\"mailto:customer-service@acme-clinic.org\">customer-service@acme-clinic.org</a></p><p><b>address</b>: 3300 WASHTENAW AVE STE 227 AMHERST MA 01002 USA </p></div>"
},
"identifier": [
{
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1407071236"
},
{
"system": "http://example.org/fhir/sid/us-tin",
"value": "121111111"
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "prov",
"display": "Healthcare Provider"
}
]
}
],
"name": "Acme Clinic",
"telecom": [
{
"system": "phone",
"value": "(+1) 734-677-7777"
},
{
"system": "email",
"value": "customer-service@acme-clinic.org"
}
],
"address": [
{
"line": [
"3300 WASHTENAW AVE STE 227"
],
"city": "AMHERST",
"state": "MA",
"postalCode": "01002",
"country": "USA"
}
]
},
"search": {
"mode": "match"
}
}
]
},
"locations": {
"resourceType": "Bundle",
"type": "searchset",
"total": 1,
"link": [
{
"relation": "self",
"url": "http://example.org/someEHR/fhir/r4/Location?_id=hospital"
}
],
"entry": [
{
"fullUrl": "http://example.org/someEHR/fhir/Location/hospital",
"resource": {
"resourceType": "Location",
"id": "hospital",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>name</b>: Acme Clinic</p><p></p><p><b>address</b>: 3300 WASHTENAW AVE STE 227 AMHERST MA 01002 USA </p></div>"
},
"address": {
"line": [
"3300 WASHTENAW AVE STE 227"
],
"city": "AMHERST",
"state": "MA",
"postalCode": "01002",
"country": "USA"
},
"managingOrganization": {
"reference": "http://example.org/someEHR/fhir/Organization/GHI"
}
},
"search": {
"mode": "include"
}
}
]
}
},
"extension": {
"davinci-crd.configuration": {
"coverage-info": false,
"cost": false,
"claim": false,
"appropriate-use": false,
"max-cards": 5
}
}
}
IG © 2019+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-crd#2.1.0 based on FHIR 4.0.1. Generated 2024-12-11
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change