Da Vinci - Coverage Requirements Discovery
2.1.0 - STU 2.1 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 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

ValueSet: CRD Coverage Detail Codes Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetail Version: 2.1.0
Standards status: Trial-use Maturity Level: 3 Computable Name: CRDCoverageDetailCodes
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.12

Codes for name-value-pair details on a coverage assertion

References

Logical Definition (CLD)

Generated Narrative: ValueSet coverageDetail

  • Include these codes as defined in http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp
    CodeDisplayDefinition
    allowed-quantityMaximum quantityIndicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity
    allowed-periodMaximum allowed periodIndicates the maximum period of time that can be covered in a single order. Value should be a Period
    in-network-copayCopay for in-networkIndicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity.
    out-network-copayCopay for out-of-networkIndicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity.
    auth-out-network-onlyAuthorization out-of-network onlyAuthorization is only necessary if out-of-network. Value should be a boolean.
    concurrent-reviewConcurrent reviewAdditional payer-defined documentation will be required prior to claim payment. Value should be a boolean.
    appropriate-use-neededAppropriate usePayer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean.
    policy-linkPolicy LinkA URL pointing to the specific portion of a payer policy, coverage agreement or similar authoritative document that provides a portion of the basis for the decision documented in the coverage-information. Value should be a url.
    instructionsInstructionsInformation to display to the user that gives guidance about what steps to take in achieving the recommended actions identified by this coverage-information (e.g. special instructions about requesting authorization, details about information needed, details about data retention, etc.). Value should be a string.
    instructions-clinicalClinical instructionsInstructions specifically intended for the use of clinical (rather than administrative staff)
    instructions-adminAdministrative InstructionsInstructions specifically intended for the use of administrative (rather than clinical staff)

 

Expansion

Generated Narrative: ValueSet

Expansion based on codesystem CRD Temporary Codes v2.1.0 (CodeSystem)

This value set contains 11 concepts

CodeSystemDisplayDefinition
  allowed-quantityhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempMaximum quantity

Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity

  allowed-periodhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempMaximum allowed period

Indicates the maximum period of time that can be covered in a single order. Value should be a Period

  in-network-copayhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempCopay for in-network

Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity.

  out-network-copayhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempCopay for out-of-network

Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity.

  auth-out-network-onlyhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempAuthorization out-of-network only

Authorization is only necessary if out-of-network. Value should be a boolean.

  concurrent-reviewhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempConcurrent review

Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean.

  appropriate-use-neededhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempAppropriate use

Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean.

  policy-linkhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempPolicy Link

A URL pointing to the specific portion of a payer policy, coverage agreement or similar authoritative document that provides a portion of the basis for the decision documented in the coverage-information. Value should be a url.

  instructionshttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempInstructions

Information to display to the user that gives guidance about what steps to take in achieving the recommended actions identified by this coverage-information (e.g. special instructions about requesting authorization, details about information needed, details about data retention, etc.). Value should be a string.

  instructions-clinicalhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempClinical instructions

Instructions specifically intended for the use of clinical (rather than administrative staff)

  instructions-adminhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempAdministrative Instructions

Instructions specifically intended for the use of administrative (rather than clinical staff)


Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code