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
Page standards status: Trial-use | Maturity Level: 2 |
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<id value="coverageDetail"/>
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<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></table></li></ul></div>
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<url value="http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetail"/>
<version value="2.1.0-preview"/>
<name value="CRDCoverageDetailCodes"/>
<title value="CRD Coverage Detail Codes Value Set"/>
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<date value="2024-09-12T03:57:38+00:00"/>
<publisher value="HL7 International / Financial Management"/>
<contact>
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<value value="http://www.hl7.org/Special/committees/fm"/>
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<description
value="Codes for name-value-pair details on a coverage assertion"/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
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<system value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
<concept>
<code value="allowed-quantity"/>
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<concept>
<code value="allowed-period"/>
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<concept>
<code value="in-network-copay"/>
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<concept>
<code value="out-network-copay"/>
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<concept>
<code value="auth-out-network-only"/>
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<code value="concurrent-review"/>
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<concept>
<code value="appropriate-use-needed"/>
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