Da Vinci - Coverage Requirements Discovery
2.2.1 - STU 2.2

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 2.2.1 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

## : CRD Coverage Assertion Reasons Value Set

Page standards status: Trial-use | Maturity Level: 1

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    <ValueSet xmlns="http://hl7.org/fhir">
      <id value="coverageAssertionReasons"/>
      <language value="en"/>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ValueSet coverageAssertionReasons</b></p><a name="coverageAssertionReasons"> </a><a name="hccoverageAssertionReasons"> </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><span title="Version is not explicitly stated, which means it is fixed to the version provided in this specification"> version &#x1F4E6;2.2.1</span><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-gold-card">gold-card</a></td><td style="color: #cccccc">Gold card</td><td>Ordering Practitioner has been granted 'gold card' status with this payer/coverage type.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-no-member-found">no-member-found</a></td><td style="color: #cccccc">Member not found</td><td>The server was unable to find a matching member or was unable to resolve to a single member, so no coverage information can be provided.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-no-active-coverage">no-active-coverage</a></td><td style="color: #cccccc">Coverage not active</td><td>The referenced coverage for the member was found but is not in force during the relevant time period for which the coverage is being evaluated.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-coverage-not-found">coverage-not-found</a></td><td style="color: #cccccc">Coverage not found</td><td>The payer is not available to resolve the provided coverage information to an existing coverage record, or it is not specific enough to resolve to a single coverage.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-auth-out-network">auth-out-network</a></td><td style="color: #cccccc">Authorization needed out-of-network</td><td>Authorization is necessary if out-of-network.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-technical">technical</a></td><td style="color: #cccccc">Technical issues</td><td>The server encountered technical issues either internally or with their interaction with the client.  It is possible these issues are transient and later calls might provide more information.</td></tr></table></li></ul></div>
      </text>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
        <valueInteger value="1"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
        <valueCode value="fm"/>
      </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/coverageAssertionReasons"/>
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:2.16.840.1.113883.4.642.40.18.48.10"/>
      </identifier>
      <version value="2.2.1"/>
      <name value="CRDCoverageAssertionReasons"/>
      <title value="CRD Coverage Assertion Reasons Value Set"/>
      <status value="active"/>
      <experimental value="false"/>
      <date value="2026-03-26T15:54:25+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="Reasons for a coverage assertion in the coverage-information extension"/>
      <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="gold-card"/>
          </concept>
          <concept>
            <code value="no-member-found"/>
          </concept>
          <concept>
            <code value="no-active-coverage"/>
          </concept>
          <concept>
            <code value="coverage-not-found"/>
          </concept>
          <concept>
            <code value="auth-out-network"/>
          </concept>
          <concept>
            <code value="technical"/>
          </concept>
        </include>
      </compose>
    </ValueSet>