Da Vinci - Coverage Requirements Discovery
2.0.1 - STU 2 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 2.0.1 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: 2.0.1
Standards status: Trial-use Maturity Level: 2 Computable Name: CRDCoverageDetailCodes

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

References

Logical Definition (CLD)

  • 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.

 

Expansion

Expansion based on codesystem CRD Temporary Codes v2.0.1 (CodeSystem)

This value set contains 7 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.


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