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 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

: CRD Coverage Detail Codes Value Set - XML Representation

Page standards status: Trial-use Maturity Level: 3

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="coverageDetail"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ValueSet coverageDetail</b></p><a name="coverageDetail"> </a><a name="hccoverageDetail"> </a><a name="coverageDetail-en-US"> </a><ul><li>Include these codes as defined in <a href="CodeSystem-temp.html"><code>http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp</code></a><table class="none"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href="CodeSystem-temp.html#temp-allowed-quantity">allowed-quantity</a></td><td style="color: #cccccc">Maximum quantity</td><td>Indicates limitations on the number of services/products allowed (possibly per time period).  Value should be a Quantity</td></tr><tr><td><a href="CodeSystem-temp.html#temp-allowed-period">allowed-period</a></td><td style="color: #cccccc">Maximum allowed period</td><td>Indicates the maximum period of time that can be covered in a single order.  Value should be a Period</td></tr><tr><td><a href="CodeSystem-temp.html#temp-in-network-copay">in-network-copay</a></td><td style="color: #cccccc">Copay for in-network</td><td>Indicates a percentage co-pay to expect if delivered in-network.  Value should be a Quantity.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-out-network-copay">out-network-copay</a></td><td style="color: #cccccc">Copay for out-of-network</td><td>Indicates a percentage co-pay to expect if delivered out-of-network.  Value should be a Quantity.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-auth-out-network-only">auth-out-network-only</a></td><td style="color: #cccccc">Authorization out-of-network only</td><td>Authorization is only necessary if out-of-network.  Value should be a boolean.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-concurrent-review">concurrent-review</a></td><td style="color: #cccccc">Concurrent review</td><td>Additional payer-defined documentation will be required prior to claim payment.  Value should be a boolean.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-appropriate-use-needed">appropriate-use-needed</a></td><td style="color: #cccccc">Appropriate use</td><td>Payer-defined appropriate use process must be invoked to determine coverage.  Value should be a boolean.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-policy-link">policy-link</a></td><td style="color: #cccccc">Policy Link</td><td>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.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-instructions">instructions</a></td><td style="color: #cccccc">Instructions</td><td>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.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-instructions-clinical">instructions-clinical</a></td><td style="color: #cccccc">Clinical instructions</td><td>Instructions specifically intended for the use of clinical (rather than administrative staff)</td></tr><tr><td><a href="CodeSystem-temp.html#temp-instructions-admin">instructions-admin</a></td><td style="color: #cccccc">Administrative Instructions</td><td>Instructions specifically intended for the use of administrative (rather than clinical staff)</td></tr></table></li></ul></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="3">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"/>
      </extension>
    </valueInteger>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"/>
      </extension>
    </valueCode>
  </extension>
  <url value="http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetail"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.40.18.48.12"/>
  </identifier>
  <version value="2.1.0"/>
  <name value="CRDCoverageDetailCodes"/>
  <title value="CRD Coverage Detail Codes Value Set"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2024-12-11T01:38:49+00:00"/>
  <publisher value="HL7 International / Financial Management"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fm"/>
    </telecom>
  </contact>
  <description
               value="Codes for name-value-pair details on a coverage assertion"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <compose>
    <include>
      <system value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
      <concept>
        <code value="allowed-quantity"/>
      </concept>
      <concept>
        <code value="allowed-period"/>
      </concept>
      <concept>
        <code value="in-network-copay"/>
      </concept>
      <concept>
        <code value="out-network-copay"/>
      </concept>
      <concept>
        <code value="auth-out-network-only"/>
      </concept>
      <concept>
        <code value="concurrent-review"/>
      </concept>
      <concept>
        <code value="appropriate-use-needed"/>
      </concept>
      <concept>
        <code value="policy-link"/>
      </concept>
      <concept>
        <code value="instructions"/>
      </concept>
      <concept>
        <code value="instructions-clinical"/>
      </concept>
      <concept>
        <code value="instructions-admin"/>
      </concept>
    </include>
  </compose>
</ValueSet>