Da Vinci - Coverage Requirements Discovery
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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

: MedicationRequest annotated example - XML Representation

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<MedicationRequest xmlns="http://hl7.org/fhir">
  <id value="annotated-example"/>
  <text>
    <status value="extensions"/>
    <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.v311@3.1.1&amp;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 --&gt; 2012-05-23</a></p><blockquote><p><b>url</b></p><a href="https://simplifier.net/resolve?scope=hl7.fhir.us.core.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;canonical=http://hl7.org/fhir/us/core/billingCode">billingCode</a></blockquote><p><b>value</b>: <a href="http://terminology.hl7.org/5.5.0/CodeSystem-CPT.html#CPT-77067">Current Procedural Terminology (CPT®)</a> 77067: 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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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.v311@3.1.1&amp;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></blockquote></div>
  </text>
  <extension
             url="http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information">
    <extension url="coverage">
      <valueReference>🔗 
        <reference value="Coverage/example"/>
      </valueReference>
    </extension>
    <extension url="covered">
      <valueCode value="conditional"/>
    </extension>
    <extension url="pa-needed">
      <valueCode value="satisfied"/>
    </extension>
    <extension url="doc-needed">
      <valueCode value="admin"/>
    </extension>
    <extension url="doc-purpose">
      <valueCode value="withclaim"/>
    </extension>
    <extension url="info-needed">
      <valueCode value="performer"/>
    </extension>
    <extension url="billingCode">
      <valueCoding>
        <system value="http://www.ama-assn.org/go/cpt"/>
        <code value="77067"/>
      </valueCoding>
    </extension>
    <extension url="reason">
      <valueCodeableConcept>
        <coding>
          <system value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
          <code value="gold-card"/>
        </coding>
        <text value="In-network required unless exigent circumstances"/>
      </valueCodeableConcept>
    </extension>
    <extension url="detail">
      <extension url="code">
        <valueCodeableConcept>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
            <code value="auth-out-network-only"/>
          </coding>
        </valueCodeableConcept>
      </extension>
      <extension url="value">
        <valueBoolean value="true"/>
      </extension>
      <extension url="qualification">
        <valueString
                     value="Out-of-network prior auth does not apply if delivery occurs at a service site designated as 'remote'"/>
      </extension>
    </extension>
    <extension url="questionnaire">
      <valueCanonical
                      value="http://example.org/some-payer/Questionnaire/123|1.3.0"/>
    </extension>
    <extension url="date">
      <valueDate value="2019-02-15"/>
    </extension>
    <extension url="coverage-assertion-id">
      <valueString value="12345ABC"/>
    </extension>
    <extension url="satisfied-pa-id">
      <valueString value="XXYYZ"/>
    </extension>
    <extension url="contact">
      <valueContactPoint>
        <system value="url"/>
        <value value="http://some-payer.org/xyz-sub-org/get-help-here.html"/>
      </valueContactPoint>
    </extension>
    <extension url="expiry-date">
      <valueDate value="2019-08-01"/>
    </extension>
  </extension>
  <status value="draft"/>
  <intent value="original-order"/>
  <medicationCodeableConcept>
    <coding>
      <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
      <code value="616447"/>
      <display value="mycophenolate mofetil 250 MG Oral Capsule [Cellcept]"/>
    </coding>
  </medicationCodeableConcept>
  <subject>
    <reference value="http://example.org/Patient/123"/>
    <display value="Jane Smith"/>
  </subject>
  <encounter>
    <reference value="http://example.org/Encounter/ABC"/>
  </encounter>
  <authoredOn value="2019-02-15"/>
  <requester>
    <reference value="http://example.org/PractitionerRole/987"/>
    <display value="Dr. Jones"/>
  </requester>
  <note>
    <authorString value="XYZ Insurance"/>
    <time value="2019-02-15T15:07:18-05:00"/>
    <text
          value="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."/>
  </note>
  <dosageInstruction>
    <text value="6 tablets every 12 hours."/>
    <timing>
      <repeat>
        <frequency value="1"/>
        <period value="12"/>
        <periodUnit value="h"/>
      </repeat>
    </timing>
    <doseAndRate>
      <doseQuantity>
        <value value="6"/>
        <unit value="tablet"/>
      </doseQuantity>
    </doseAndRate>
  </dosageInstruction>
</MedicationRequest>