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
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
Generated Narrative: ValueSet coverageDetail
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp
Code | Display | Definition |
allowed-quantity | Maximum quantity | Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity |
allowed-period | Maximum allowed period | Indicates the maximum period of time that can be covered in a single order. Value should be a Period |
in-network-copay | Copay for in-network | Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity. |
out-network-copay | Copay for out-of-network | Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity. |
auth-out-network-only | Authorization out-of-network only | Authorization is only necessary if out-of-network. Value should be a boolean. |
concurrent-review | Concurrent review | Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean. |
appropriate-use-needed | Appropriate use | Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean. |
policy-link | Policy 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. |
instructions | Instructions | 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-clinical | Clinical instructions | Instructions specifically intended for the use of clinical (rather than administrative staff) |
instructions-admin | Administrative Instructions | Instructions specifically intended for the use of administrative (rather than clinical staff) |
Generated Narrative: ValueSet
Expansion based on codesystem CRD Temporary Codes v2.1.0 (CodeSystem)
This value set contains 11 concepts
Code | System | Display | Definition |
allowed-quantity | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Maximum quantity | Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity |
allowed-period | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Maximum allowed period | Indicates the maximum period of time that can be covered in a single order. Value should be a Period |
in-network-copay | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Copay for in-network | Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity. |
out-network-copay | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Copay for out-of-network | Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity. |
auth-out-network-only | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Authorization out-of-network only | Authorization is only necessary if out-of-network. Value should be a boolean. |
concurrent-review | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Concurrent review | Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean. |
appropriate-use-needed | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Appropriate use | Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean. |
policy-link | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Policy 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. |
instructions | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Instructions | 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-clinical | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Clinical instructions | Instructions specifically intended for the use of clinical (rather than administrative staff) |
instructions-admin | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Administrative 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 |