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
| Page standards status: Informative |
{
"resourceType" : "MedicationRequest",
"id" : "annotated-example",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: MedicationRequest annotated-example</b></p><a name=\"annotated-example\"> </a><a name=\"hcannotated-example\"> </a><a name=\"annotated-example-en-US\"> </a><blockquote><p><b>Coverage Information</b></p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/coverage\">coverage</a></blockquote><p><b>value</b>: <a href=\"Coverage-example.html\">Coverage: identifier = Member Number; status = active; type = extended healthcare; dependent = 0; relationship = Self; period = 2011-05-23 --> 2012-05-23</a></p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/covered\">covered</a></blockquote><p><b>value</b>: conditional</p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/pa-needed\">pa-needed</a></blockquote><p><b>value</b>: satisfied</p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/doc-needed\">doc-needed</a></blockquote><p><b>value</b>: admin</p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/doc-purpose\">doc-purpose</a></blockquote><p><b>value</b>: withclaim</p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/info-needed\">info-needed</a></blockquote><p><b>value</b>: performer</p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/billingCode\">billingCode</a></blockquote><p><b>value</b>: <a href=\"http://terminology.hl7.org/5.0.0/CodeSystem-CPT.html#CPT-77067\">Current Procedural Terminology (CPT®) 77067</a>: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed</p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/reason\">reason</a></blockquote><p><b>value</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp gold-card}\">In-network required unless exigent circumstances</span></p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp auth-out-network-only}\">Authorization out-of-network only</span></p><p><b>value</b>: true</p><p><b>qualification</b>: Out-of-network prior auth does not apply if delivery occurs at a service site designated as 'remote'</p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/detail\">detail</a></blockquote><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/questionnaire\">questionnaire</a></blockquote><p><b>value</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://example.org/some-payer/Questionnaire/123|1.3.0\">http://example.org/some-payer/Questionnaire/123|1.3.0</a></p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/date\">date</a></blockquote><p><b>value</b>: 2019-02-15</p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/coverage-assertion-id\">coverage-assertion-id</a></blockquote><p><b>value</b>: 12345ABC</p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/satisfied-pa-id\">satisfied-pa-id</a></blockquote><p><b>value</b>: XXYYZ</p><blockquote><p><b>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/contact\">contact</a></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>url</b></p><a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://hl7.org/fhir/us/core/expiry-date\">expiry-date</a></blockquote><p><b>value</b>: 2019-08-01</p></blockquote><p><b>status</b>: Draft</p><p><b>intent</b>: Original Order</p><p><b>medication</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 616447}\">mycophenolate mofetil 250 MG Oral Capsule [Cellcept]</span></p><p><b>subject</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=http://example.org/Patient/123\">Jane Smith</a></p><p><b>encounter</b>: <a href=\"https://simplifier.net/resolve?scope=hl7.fhir.us.core.v610@6.1.0&canonical=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.v610@6.1.0&canonical=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 @2019-02-15 15:07:18-0500)</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><h3>DoseAndRates</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Dose[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>6 tablet</td></tr></table></blockquote></div>"
},
"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" : "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" : "expiry-date",
"valueDate" : "2019-08-01"
}
],
"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 based on FHIR 4.0.1. Generated 2024-12-11
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