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": [
{
"extension": {
"davinci-crd.associated-resource": [
{
"reference": "MedicationRequest/2222"
}
]
},
"uuid": "a1c2d18b-bc29-4ce9-be70-f6c26e1d78d8",
"summary": "Replace order with covered generic?",
"indicator": "info",
"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-req",
"display": "Required Therapy Alternatives"
}
},
"suggestions": [
{
"label": "Change to lower price name brand (selected name brand not covered)",
"actions": [
{
"type": "delete",
"description": "Remove name-brand prescription",
"resourceId": [
"MedicationRequest/2222"
]
},
{
"type": "create",
"description": "Add lower-cost alternative",
"resource": {
"resourceType": "MedicationRequest",
"id": "1",
"status": "draft",
"intent": "original-order",
"medicationCodeableConcept": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "1790533",
"display": "Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza]"
}
]
},
"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/123"
},
"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"
}
}
}
}
]
}
]
},
{
"extension": {
"davinci-crd.associated-resource": [
{
"reference": "MedicationRequest/1111"
}
]
},
"uuid": "9cda1f90-48ce-4b1e-abc7-970c65c4bab9",
"summary": "Liver testing recommended",
"detail": "Administration of Diclofenac should be accompanied by SGPT monitoring due to potential toxicity",
"indicator": "info",
"source": {
"label": "Centers for Medicare & Medicaid Services",
"url": "https://cms.gov",
"topic": {
"system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"code": "clinical-reminder",
"display": "Clinical Reminder"
}
},
"suggestions": [
{
"label": "Add monthly AST test for 1st 3 months",
"actions": [
{
"type": "create",
"description": "Add order for AST test",
"resource": {
"resourceType": "ServiceRequest",
"id": "1",
"status": "draft",
"intent": "original-order",
"category": [
{
"coding": [
{
"system": "http://snomed.info/sct",
"code": "108252007",
"display": "Laboratory procedure"
}
]
}
],
"code": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "80076",
"display": "Hepatic function panel"
}
]
},
"subject": {
"reference": "http://example.org/fhir/Patient/123",
"display": "Jane Smith"
},
"encounter": {
"reference": "http://example.org/fhir/Encounter/ABC"
},
"occurrenceTiming": {
"repeat": {
"boundsDuration": {
"value": 3,
"unit": "months",
"code": "mo",
"system": "http://unitsofmeasure.org"
},
"frequency": 1,
"period": 1,
"periodUnit": "mo"
}
},
"authoredOn": "2019-02-15",
"requester": {
"reference": "http://example.org/fhir/PractitionerRole/987",
"display": "Dr. Jones"
}
}
}
]
}
]
},
{
"extension": {
"davinci-crd.associated-resource": [
{
"reference": "MedicationRequest/2222"
}
]
},
"uuid": "ba18576a-1905-4e2c-b5fd-cf04171dc291",
"summary": "Complete Opiod Use form",
"detail": "Form ABC is required to attest to appropriate opiod usage",
"indicator": "info",
"source": {
"label": "Centers for Medicare & Medicaid Services",
"url": "https://cms.gov",
"topic": {
"system": "http://example.org/fhir/CodeSystem/SomeCodes",
"code": "123",
"display": "Regulatory Requirement"
}
},
"suggestions": [
{
"label": "Add 'completion of the ABC form' to your task list (possibly for reassignment)",
"actions": [
{
"type": "create",
"description": "Add version 2 of the XYZ form to the clinical system's repository (if it doesn't already exist)",
"resource": {
"resourceType": "Questionnaire",
"id": "1",
"url": "http://example.org/Questionnaire/XYZ",
"version": "2",
"status": "active",
"item": [
{
"linkId": "1",
"text": "Has the patient previously tried non-opioid therapy and been unsuccessful?",
"type": "boolean"
}
]
},
"extension": {
"davinci-crd.if-none-exist": "url=http://example.org/Questionnaire/XYZ&version=2"
}
},
{
"type": "create",
"description": "Add 'Complete ABC form' to the task list",
"resource": {
"resourceType": "Task",
"id": "1",
"basedOn": [
{
"reference": "http://example.org/fhir/Appointment/27"
}
],
"status": "ready",
"intent": "order",
"code": {
"coding": [
{
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
"code": "complete-questionnaire"
}
]
},
"description": "Complete XYZ form for local retention",
"for": {
"reference": "http://example.org/fhir/Patient/123"
},
"authoredOn": "2018-08-09",
"input": [
{
"type": {
"text": "questionnaire"
},
"valueCanonical": "http://example.org/Questionnaire/XYZ|2"
},
{
"type": {
"text": "afterCompletion"
},
"valueCodeableConcept": {
"coding": [
{
"system": "http://example.org/fhir/CodeSystem/SomeCodes",
"code": "987",
"display": "Local Use"
}
]
}
}
]
}
}
]
}
]
},
{
"uuid": "5561ec1e-78c5-48aa-8fc0-037c476452bf",
"summary": "Patient coverage information is incomplete",
"indicator": "info",
"source": {
"label": "Some Payer",
"url": "https://example.com",
"icon": "https://example.com/img/icon-100px.png",
"topic": {
"system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"code": "insurance",
"display": "Insurance"
}
},
"suggestions": [
{
"label": "Update coverage information to be current",
"uuid": "1207df9d-9ff6-4042-985b-b8dec21038c2",
"actions": [
{
"type": "update",
"description": "Update current coverage record",
"resource": {
"resourceType": "Coverage",
"id": "1234",
"status": "active",
"subscriberId": "192837",
"beneficiary": {
"reference": "http://example.org/fhir/Patient/123"
},
"period": {
"start": "2023-01-01",
"end": "2023-11-30"
},
"payor": [
{
"reference": "http://example.org/fhir/Organization/ABC"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "group"
}
]
},
"value": "A1"
}
]
}
}
]
}
]
},
{
"extension": {
"davinci-crd.associated-resource": [
{
"reference": "MedicationRequest/2222"
}
]
},
"uuid": "353cd963-2ecd-46f9-958b-ed7d2bbf6e01",
"summary": "Launch opioid XYZ-assessment",
"indicator": "info",
"source": {
"label": "Some Payer",
"url": "https://example.com",
"icon": "https://example.com/img/icon-100px.png",
"topic": {
"system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"code": "guideline",
"display": "Guideline"
}
},
"links": [
{
"label": "Opioid XYZ-assessment",
"url": "https://example.org/opioid-assessment",
"type": "smart",
"appContext": "{\"payerXYZQNum\":\"205f471f-f408-45d4-9213-0eedf95f417f\"}"
}
]
}
]
}
IG © 2019+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-crd#2.1.0 based on FHIR 4.0.1. Generated 2024-11-20
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