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
{
"cards": [
{
"summary": "Patient is overdue for a PAP smear",
"indicator": "info",
"detail": "Last date on record for a PAP test for this patient was May, 2014. Tests should ideally be performed every 1-3 years",
"source": {
"label": "You're Covered Insurance",
"url": "https://example.com",
"icon": "https://example.com/img/icon-100px.png",
"topic": {
"system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"code": "clinical-reminder",
"display": "Clinical Reminder"
}
}
},
{
"extension": {
"davinci-crd.associated-resource": [
{
"reference": "ServiceRequest/2468"
}
]
},
"uuid": "07bc9814-9d2a-11ee-8c90-0242ac120002",
"summary": "CMS Home Oxygen Therapy Coverage Requirements",
"indicator": "info",
"detail": "Learn about covered oxygen items and equipment for home use; coverage requirements; criteria you must meet to furnish oxygen items and equipment for home use; Advance Beneficiary Notice of Noncoverage; oxygen equipment, items, and services that are not covered; and payments for oxygen items and equipment and billing and coding guidelines.",
"source": {
"label": "Centers for Medicare & Medicaid Services",
"url": "https://cms.gov",
"topic": {
"system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"code": "guideline",
"display": "Guideline"
}
},
"links": [
{
"label": "Home Oxygen Therapy Guidelines",
"url": "https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Home-Oxygen-Therapy-ICN908804.pdf",
"type": "absolute"
},
{
"label": "Home Oxygen Therapy Guidelines (printer-friendly)",
"url": "https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Home-Oxygen-Therapy-Text-Only.pdf",
"type": "absolute"
}
]
},
{
"extension": {
"davinci-crd.associated-resource": [
{
"reference": "ServiceRequest/2468"
}
]
},
"uuid": "0941cda0-91d7-42db-b5af-0ebbef2507bf",
"summary": "Replace rental order with purchase order (to reduce long-term costs)",
"indicator": "info",
"detail": "Mrs. Baxter has been on home oxygen for over 18 months and purchase is more efficient. Payer XYZ has negotiated a discount on Acme brand portable oxygen systems which will result in a cost only slightly higher than anual rental",
"source": {
"label": "Centers for Medicare & Medicaid Services",
"url": "https://cms.gov",
"topic": {
"system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"code": "therapy-alternatives-opt",
"display": "Optional Therapy Alternatives"
}
},
"suggestions": [
{
"label": "Change to an order for purchase",
"actions": [
{
"type": "delete",
"description": "Remove rental order",
"resourceId": "ServiceRequest/2468"
},
{
"type": "create",
"description": "Add purchase order",
"resource": {
"resourceType": "ServiceRequest",
"id": "AAA",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing for Amy V. Baxter<br/>Requested by Dr. Jones, Feb 15, 2019</div>"
},
"status": "draft",
"intent": "original-order",
"code": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
"code": "E0430",
"display": "Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing"
}
]
},
"subject": {
"reference": "http://example.org/fhir/Patient/123"
},
"encounter": {
"reference": "http://example.org/fhir/Encounter/987"
},
"authoredOn": "2019-02-15",
"requester": {
"reference": "http://example.org/fhir/PractitionerRole/ABC",
"display": "Dr. Jones"
}
}
},
{
"type": "create",
"description": "Add specific (discounted) device order",
"resource": {
"resourceType": "DeviceRequest",
"id": "BBB",
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Order for Acme ZZZ portable gaseous oxygen system for Amy V. Baxter<br/>Requested by Dr. Jones, Feb 15, 2019</div>"
},
"basedOn": [
{
"reference": "http://example.org/ServiceRequest/AAA"
}
],
"status": "draft",
"intent": "original-order",
"codeCodeableConcept": {
"coding": [
{
"system": "https://example.org/some-organization/device-codes",
"code": "ZZZ",
"display": "Acme ZZZ Portable gaseous oxygen system"
}
]
},
"subject": {
"reference": "http://example.org/fhir/Patient/123"
},
"encounter": {
"reference": "http://example.org/fhir/Encounter/987"
},
"authoredOn": "2019-02-15",
"requester": {
"reference": "http://example.org/fhir/PractitionerRole/ABC",
"display": "Dr. Jones"
}
}
}
]
}
],
"selectionBehavior": "any"
}
],
"systemActions": [
{
"type": "update",
"resource": {
"resourceType": "ServiceRequest",
"id": "idfromcontext",
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information",
"extension": [
{
"url": "coverage",
"valueReference": {
"reference": "http://example.org/fhir/Coverage/example"
}
},
{
"url": "covered",
"valueCode": "covered"
},
{
"url": "pa-needed",
"valueCode": "satisfied"
},
{
"url": "billingCode",
"valueCoding": {
"system": "http://www.ama-assn.org/go/cpt",
"code": "77065"
}
},
{
"url": "billingCode",
"valueCoding": {
"system": "http://www.ama-assn.org/go/cpt",
"code": "77066"
}
},
{
"url": "billingCode",
"valueCoding": {
"system": "http://www.ama-assn.org/go/cpt",
"code": "77067"
}
},
{
"url": "reason",
"valueCodeableConcept": {
"text": "In-network required unless exigent circumstances"
}
},
{
"url": "detail",
"extension": [
{
"url": "code",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"code": "auth-out-network-only"
}
]
}
},
{
"url": "value",
"valueBoolean": true
},
{
"url": "qualification",
"valueString": "Out-of-network prior auth does not apply if delivery occurs at a service site designated as 'remote'"
}
]
},
{
"url": "dependency",
"valueReference": {
"reference": "http://example.org/fhir/ServiceRequest/example2"
}
},
{
"url": "date",
"valueDate": "2019-02-15"
},
{
"url": "coverage-assertion-id",
"valueString": "12345ABC"
},
{
"url": "satisfied-pa-id",
"valueString": "Q8U119"
},
{
"url": "contact",
"valueContactPoint": {
"system": "url",
"value": "http://some-payer/xyz-sub-org/get-help-here.html"
}
}
]
}
],
"status": "draft",
"intent": "original-order",
"code": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "726551006",
"display": "Contrast enhanced spectral mammography (Procedure)"
}
]
},
"subject": {
"reference": "http://example.org/fhir/Patient/123",
"display": "Jane Smith"
},
"encounter": {
"reference": "http://example.org/fhir/Encounter/987"
},
"authoredOn": "2019-02-15",
"requester": {
"reference": "http://example.org/fhir/PractitionerRole/ABC",
"display": "Dr. Jones"
}
}
}
]
}
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
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