Da Vinci - Coverage Requirements Discovery
2.1.0-preview - STU 2 United States of America flag

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-preview 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

Binary: Example CRD Service Response

    
{
  "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": [
          "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": [
          "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": "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"
                }
              }
            }
          ]
        }
      ]
    }
  ],
  "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"
        }
      }
    }
  ]
}