Da Vinci - Coverage Requirements Discovery
2.1.0 - STU 2.1 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 2.1.0 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 Information Prior Authorization Value Set - TTL Representation

Page standards status: Trial-use Maturity Level: 1

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:ValueSet ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "coveragePaDetail"] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir: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>"
  ] ; # 
  fhir:extension ( [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ] ;
fhir:value [ fhir:v "1"^^xsd:integer ]
  ] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ] ;
fhir:value [ fhir:v "fm" ]
  ] [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ] ;
fhir:value [
fhir:v "trial-use" ;
      ( fhir:extension [
fhir:url [ fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ] ;
fhir:value [
fhir:v "http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"^^xsd:anyURI ;
fhir:link <http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd>         ]       ] )     ]
  ] ) ; # 
  fhir:url [ fhir:v "http://hl7.org/fhir/us/davinci-crd/ValueSet/coveragePaDetail"^^xsd:anyURI] ; # 
  fhir:version [ fhir:v "2.1.0"] ; # 
  fhir:name [ fhir:v "CRDCoveragePaDetail"] ; # 
  fhir:title [ fhir:v "CRD Coverage Information Prior Authorization Value Set"] ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:experimental [ fhir:v "false"^^xsd:boolean] ; # 
  fhir:date [ fhir:v "2024-11-13T17:51:25+00:00"^^xsd:dateTime] ; # 
  fhir:publisher [ fhir:v "HL7 International / Financial Management"] ; # 
  fhir:contact ( [
    ( fhir:telecom [
fhir:system [ fhir:v "url" ] ;
fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ]     ] )
  ] ) ; # 
  fhir:description [ fhir:v "Codes defining whether prior auth will be needed for coverage to be provided"] ; # 
  fhir:jurisdiction ( [
    ( fhir:coding [
fhir:system [ fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ] ;
fhir:code [ fhir:v "US" ]     ] )
  ] ) ; # 
  fhir:compose [
    ( fhir:include [
fhir:system [ fhir:v "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"^^xsd:anyURI ] ;
      ( fhir:concept [
fhir:code [ fhir:v "no-auth" ]       ] [
fhir:code [ fhir:v "auth-needed" ]       ] [
fhir:code [ fhir:v "satisfied" ]       ] [
fhir:code [ fhir:v "performpa" ]       ] [
fhir:code [ fhir:v "conditional" ]       ] )     ] )
  ] . #