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

• Narrative Content
• XML
• JSON
• TTL

: CRD Coverage Information Prior Authorization Value Set - JSON Representation

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{
  "resourceType" : "ValueSet",
  "id" : "coveragePaDetail",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet coveragePaDetail</b></p><a name=\"coveragePaDetail\"> </a><a name=\"hccoveragePaDetail\"> </a><a name=\"coveragePaDetail-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-no-auth\">no-auth</a></td><td style=\"color: #cccccc\">No Prior Authorization</td><td>The ordered service does not require prior authorization</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-auth-needed\">auth-needed</a></td><td style=\"color: #cccccc\">Prior Authorization Needed</td><td>The ordered service will require prior authorization</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-satisfied\">satisfied</a></td><td style=\"color: #cccccc\">Authorization Satisfied</td><td>While prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-performpa\">performpa</a></td><td style=\"color: #cccccc\">Performer Prior Authorization</td><td>Prior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-conditional\">conditional</a></td><td style=\"color: #cccccc\">Conditional</td><td>There is the potential for information requirements from a participant type not listed.  However, a decision on whether there in fact are additional information requirements cannot be made without more information (more detailed code, service rendering information, etc.)</td></tr></table></li></ul></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger" : 1
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "fm"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/davinci-crd/ValueSet/coveragePaDetail",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.4.642.40.18.48.14"
    }
  ],
  "version" : "2.1.0",
  "name" : "CRDCoveragePaDetail",
  "title" : "CRD Coverage Information Prior Authorization Value Set",
  "status" : "active",
  "experimental" : false,
  "date" : "2024-12-11T01:38:49+00:00",
  "publisher" : "HL7 International / Financial Management",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fm"
        }
      ]
    }
  ],
  "description" : "Codes defining whether prior auth will be needed for coverage to be provided",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "compose" : {
    "include" : [
      {
        "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
        "concept" : [
          {
            "code" : "no-auth"
          },
          {
            "code" : "auth-needed"
          },
          {
            "code" : "satisfied"
          },
          {
            "code" : "performpa"
          },
          {
            "code" : "conditional"
          }
        ]
      }
    ]
  }
}