Da Vinci - Coverage Requirements Discovery
2.1.0-preview - STU 2
Da Vinci - Coverage Requirements Discovery
2.1.0-preview - STU 2
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
| Page standards status: Informative |
{
"resourceType" : "MedicationRequest",
"id" : "annotated-example",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative: MedicationRequest</b><a name=\"annotated-example\"> </a><a name=\"hcannotated-example\"> </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 MedicationRequest "annotated-example" </p></div><blockquote><p><b>Coverage Information</b></p><blockquote><p><b>url</b></p><code>coverage</code></blockquote><p><b>value</b>: <a href=\"Coverage-example.html\">Coverage/example</a></p><blockquote><p><b>url</b></p><code>covered</code></blockquote><p><b>value</b>: conditional</p><blockquote><p><b>url</b></p><code>pa-needed</code></blockquote><p><b>value</b>: satisfied</p><blockquote><p><b>url</b></p><code>doc-needed</code></blockquote><p><b>value</b>: admin</p><blockquote><p><b>url</b></p><code>doc-purpose</code></blockquote><p><b>value</b>: withclaim</p><blockquote><p><b>url</b></p><code>info-needed</code></blockquote><p><b>value</b>: performer</p><blockquote><p><b>url</b></p><code>billingCode</code></blockquote><p><b>value</b>: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed (Details: http://www.ama-assn.org/go/cpt code 77067 = 'Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed', stated as 'null')</p><blockquote><p><b>url</b></p><code>reason</code></blockquote><p><b>value</b>: In-network required unless exigent circumstances <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-temp.html\">CRD Temporary Codes</a>#gold-card)</span></p><p><b>code</b>: Authorization out-of-network only <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"CodeSystem-temp.html\">CRD Temporary Codes</a>#auth-out-network-only)</span></p><blockquote><p><b>url</b></p><code>detail</code></blockquote><blockquote><p><b>url</b></p><code>questionnaire</code></blockquote><p><b>value</b>: <a href=\"http://example.org/some-payer/Questionnaire/123\">http://example.org/some-payer/Questionnaire/123|1.3.0</a></p><blockquote><p><b>url</b></p><code>response</code></blockquote><p><b>value</b>: <a name=\"hcqr\"> </a></p><blockquote><p/><p><a name=\"qr\"> </a></p><p><a name=\"hcqr\"> </a></p><p><b>questionnaire</b>: <a href=\"http://example.org/some-payer/Questionnaire/123\">http://example.org/some-payer/Questionnaire/123|1.3.0</a></p><p><b>status</b>: in-progress</p><p><b>subject</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&canonical=http://example.org/Patient/123\">http://example.org/Patient/123: Jane Smith</a></p><p><b>authored</b>: 2019-02-15</p><p><b>author</b>: <span>: Some payer app name</span></p><blockquote><p><b>item</b></p><p><b>linkId</b>: A1234</p><p><b>text</b>: How many previous treatments have been tried for this issue?</p><h3>Answers</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>2</td></tr></table></blockquote></blockquote><blockquote><p><b>url</b></p><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></blockquote><p><b>value</b>: 2019-02-15</p><blockquote><p><b>url</b></p><code>coverage-assertion-id</code></blockquote><p><b>value</b>: 12345ABC</p><blockquote><p><b>url</b></p><code>satisfied-pa-id</code></blockquote><p><b>value</b>: XXYYZ</p><blockquote><p><b>url</b></p><code>contact</code></blockquote><p><b>value</b>: <a href=\"http://some-payer.org/xyz-sub-org/get-help-here.html\">http://some-payer.org/xyz-sub-org/get-help-here.html</a></p></blockquote><p><b>status</b>: draft</p><p><b>intent</b>: original-order</p><p><b>medication</b>: mycophenolate mofetil 250 MG Oral Capsule [Cellcept] <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/5.3.0/CodeSystem-v3-rxNorm.html\">RxNorm</a>#616447)</span></p><p><b>subject</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&canonical=http://example.org/Patient/123\">http://example.org/Patient/123: Jane Smith</a></p><p><b>encounter</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&canonical=http://example.org/Encounter/ABC\">http://example.org/Encounter/ABC</a></p><p><b>authoredOn</b>: 2019-02-15</p><p><b>requester</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.3.1.1@3.1.1&canonical=http://example.org/PractitionerRole/987\">http://example.org/PractitionerRole/987: Dr. Jones</a></p><p><b>note</b>: Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted. Please note prior authorization # 12345 on claim submission. (By XYZ Insurance @Feb 15, 2019, 8:07:18\u202fPM)</p><blockquote><p><b>dosageInstruction</b></p><p><b>text</b>: 6 tablets every 12 hours.</p><p><b>timing</b>: Once per 12 hours</p><blockquote><p><b>doseAndRate</b></p></blockquote></blockquote><hr/><blockquote><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"The linkId for the item\">LinkId</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the the itemcan appear in the instance\">Definition</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Answer</a><span style=\"float: right\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireResponseRoot\" class=\"hierarchy\"/> qr</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire:http://example.org/some-payer/Questionnaire/123|1.3.0</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Item\" class=\"hierarchy\"/> A1234</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How many previous treatments have been tried for this issue?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">2</td></tr>\r\n<tr><td colspan=\"4\" class=\"hierarchy\"><br/><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></blockquote></div>"
},
"contained" : [
{
"resourceType" : "QuestionnaireResponse",
"id" : "qr",
"questionnaire" : "http://example.org/some-payer/Questionnaire/123|1.3.0",
"status" : "in-progress",
"subject" : {
"reference" : "http://example.org/Patient/123",
"display" : "Jane Smith"
},
"authored" : "2019-02-15",
"author" : {
"identifier" : {
"system" : "http://some-payer.org/xyz-sub-org/identifiers/application-ids",
"value" : "payer-CRD-service-id"
},
"display" : "Some payer app name"
},
"item" : [
{
"linkId" : "A1234",
"text" : "How many previous treatments have been tried for this issue?",
"answer" : [
{
"valueInteger" : 2
}
]
}
]
}
],
"extension" : [
{
"extension" : [
{
"url" : "coverage",
"valueReference" : {
🔗 "reference" : "Coverage/example"
}
},
{
"url" : "covered",
"valueCode" : "conditional"
},
{
"url" : "pa-needed",
"valueCode" : "satisfied"
},
{
"url" : "doc-needed",
"valueCode" : "admin"
},
{
"url" : "doc-purpose",
"valueCode" : "withclaim"
},
{
"url" : "info-needed",
"valueCode" : "performer"
},
{
"url" : "billingCode",
"valueCoding" : {
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "77067"
}
},
{
"url" : "reason",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"code" : "gold-card"
}
],
"text" : "In-network required unless exigent circumstances"
}
},
{
"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" : "detail"
},
{
"url" : "questionnaire",
"valueCanonical" : "http://example.org/some-payer/Questionnaire/123|1.3.0"
},
{
"url" : "response",
"valueReference" : {
"reference" : "#qr"
}
},
{
"url" : "date",
"valueDate" : "2019-02-15"
},
{
"url" : "coverage-assertion-id",
"valueString" : "12345ABC"
},
{
"url" : "satisfied-pa-id",
"valueString" : "XXYYZ"
},
{
"url" : "contact",
"valueContactPoint" : {
"system" : "url",
"value" : "http://some-payer.org/xyz-sub-org/get-help-here.html"
}
}
],
"url" : "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"
}
],
"status" : "draft",
"intent" : "original-order",
"medicationCodeableConcept" : {
"coding" : [
{
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "616447",
"display" : "mycophenolate mofetil 250 MG Oral Capsule [Cellcept]"
}
]
},
"subject" : {
"reference" : "http://example.org/Patient/123",
"display" : "Jane Smith"
},
"encounter" : {
"reference" : "http://example.org/Encounter/ABC"
},
"authoredOn" : "2019-02-15",
"requester" : {
"reference" : "http://example.org/PractitionerRole/987",
"display" : "Dr. Jones"
},
"note" : [
{
"authorString" : "XYZ Insurance",
"time" : "2019-02-15T15:07:18-05:00",
"text" : "Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted. Please note prior authorization # 12345 on claim submission."
}
],
"dosageInstruction" : [
{
"text" : "6 tablets every 12 hours.",
"timing" : {
"repeat" : {
"frequency" : 1,
"period" : 12,
"periodUnit" : "h"
}
},
"doseAndRate" : [
{
"doseQuantity" : {
"value" : 6,
"unit" : "tablet"
}
}
]
}
]
}
IG © 2019+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-crd#2.1.0-preview based on FHIR 4.0.1. Generated 2024-04-15
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