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

## : MedicationRequest annotated example

Page standards status: Informative

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    <MedicationRequest xmlns="http://hl7.org/fhir">
      <id value="annotated-example"/>
      <language value="en"/>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"><p class="res-header-id"><b>Generated Narrative: MedicationRequest annotated-example</b></p><a name="annotated-example"> </a><a name="hcannotated-example"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Language: en</p></div><blockquote><p><b>Coverage Information</b></p><blockquote><p><b>url</b></p>coverage</blockquote><p><b>value</b>: <a href="Coverage-example.html">Coverage: identifier = Member Number; status = active; type = extended healthcare; dependent = 0; relationship = Self; period = 2011-05-23 --&gt; 2012-05-23</a></p><blockquote><p><b>url</b></p>covered</blockquote><p><b>value</b>: conditional</p><blockquote><p><b>url</b></p>pa-needed</blockquote><p><b>value</b>: satisfied</p><blockquote><p><b>url</b></p>doc-needed</blockquote><p><b>value</b>: admin</p><blockquote><p><b>url</b></p>doc-purpose</blockquote><p><b>value</b>: withclaim</p><blockquote><p><b>url</b></p>info-needed</blockquote><p><b>value</b>: performer</p><blockquote><p><b>url</b></p>billingCode</blockquote><p><b>value</b>: <a href="http://terminology.hl7.org/6.5.0/CodeSystem-CPT.html#CPT-77067">Current Procedural Terminology (CPT®): 77067</a> (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed)</p><blockquote><p><b>url</b></p>reason</blockquote><p><b>value</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp gold-card}">Prior auth waved due to gold-card status</span></p><p><b>category</b>: cat-other</p><p><b>code</b>: <span title="Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp policy-link}">Policy Link</span></p><p><b>value</b>: <a href="http://example.org/somepayer/policy123.pdf#abc">http://example.org/somepayer/policy123.pdf#abc</a></p><p><b>qualification</b>: Additional policy details can be found here</p><blockquote><p><b>url</b></p>detail</blockquote><blockquote><p><b>url</b></p>questionnaire</blockquote><p><b>value</b>: <code>http://example.org/some-payer/Questionnaire/123|1.3.0</code></p><blockquote><p><b>url</b></p><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</a></blockquote><p><b>value</b>: 2019-02-15</p><blockquote><p><b>url</b></p>coverage-assertion-id</blockquote><p><b>value</b>: 12345ABC</p><blockquote><p><b>url</b></p>satisfied-pa-id</blockquote><p><b>value</b>: XXYYZ</p><blockquote><p><b>url</b></p>contact</blockquote><p><b>value</b>: Help Desk: <a href="http://some-payer.org/xyz-sub-org/get-help-here.html">http://some-payer.org/xyz-sub-org/get-help-here.html</a></p><blockquote><p><b>url</b></p>expiry-date</blockquote><p><b>value</b>: 2019-08-01</p></blockquote><p><b>status</b>: Draft</p><p><b>intent</b>: Original Order</p><p><b>medication</b>: <span title="Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 616447}">mycophenolate mofetil 250 MG Oral Capsule [Cellcept]</span></p><p><b>subject</b>: <a href="http://example.org/Patient/123">Jane Smith</a></p><p><b>encounter</b>: <a href="http://example.org/Encounter/ABC">http://example.org/Encounter/ABC</a></p><p><b>authoredOn</b>: 2019-02-15</p><p><b>requester</b>: <a href="http://example.org/PractitionerRole/987">Dr. Jones</a></p><p><b>note</b>: By XYZ Insurance @2019-02-15 15:07:18-0500</p><blockquote><div><p>Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted.  Please note prior authorization # 12345 on claim submission.</p>
    </div></blockquote><blockquote><p><b>dosageInstruction</b></p><p><b>text</b>: 6 tablets every 12 hours.</p><p><b>timing</b>: Once per 12 hours</p><h3>DoseAndRates</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Dose[x]</b></td></tr><tr><td style="display: none">*</td><td>6 tablet</td></tr></table></blockquote></div>
      </text>
      <extension
                 url="http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information">
        <extension url="coverage">
          <valueReference>🔗
            <reference value="Coverage/example"/>
          </valueReference>
        </extension>
        <extension url="covered">
          <valueCode value="conditional"/>
        </extension>
        <extension url="pa-needed">
          <valueCode value="satisfied"/>
        </extension>
        <extension url="doc-needed">
          <valueCode value="admin"/>
        </extension>
        <extension url="doc-purpose">
          <valueCode value="withclaim"/>
        </extension>
        <extension url="info-needed">
          <valueCode value="performer"/>
        </extension>
        <extension url="billingCode">
          <valueCoding>
            <system value="http://www.ama-assn.org/go/cpt"/>
            <code value="77067"/>
          </valueCoding>
        </extension>
        <extension url="reason">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
              <code value="gold-card"/>
            </coding>
            <text value="Prior auth waved due to gold-card status"/>
          </valueCodeableConcept>
        </extension>
        <extension url="detail">
          <extension url="category">
            <valueCode value="cat-other"/>
          </extension>
          <extension url="code">
            <valueCodeableConcept>
              <coding>
                <system
                        value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
                <code value="policy-link"/>
              </coding>
            </valueCodeableConcept>
          </extension>
          <extension url="value">
            <valueUrl value="http://example.org/somepayer/policy123.pdf#abc"/>
          </extension>
          <extension url="qualification">
            <valueString value="Additional policy details can be found here"/>
          </extension>
        </extension>
        <extension url="questionnaire">
          <valueCanonical
                          value="http://example.org/some-payer/Questionnaire/123|1.3.0"/>
        </extension>
        <extension url="date">
          <valueDate value="2019-02-15"/>
        </extension>
        <extension url="coverage-assertion-id">
          <valueString value="12345ABC"/>
        </extension>
        <extension url="satisfied-pa-id">
          <valueString value="XXYYZ"/>
        </extension>
        <extension url="contact">
          <valueContactDetail>
            <name value="Help Desk"/>
            <telecom>
              <system value="url"/>
              <value
                     value="http://some-payer.org/xyz-sub-org/get-help-here.html"/>
            </telecom>
          </valueContactDetail>
        </extension>
        <extension url="expiry-date">
          <valueDate value="2019-08-01"/>
        </extension>
      </extension>
      <status value="draft"/>
      <intent value="original-order"/>
      <medicationCodeableConcept>
        <coding>
          <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
          <code value="616447"/>
          <display value="mycophenolate mofetil 250 MG Oral Capsule [Cellcept]"/>
        </coding>
      </medicationCodeableConcept>
      <subject>
        <reference value="http://example.org/Patient/123"/>
        <display value="Jane Smith"/>
      </subject>
      <encounter>
        <reference value="http://example.org/Encounter/ABC"/>
      </encounter>
      <authoredOn value="2019-02-15"/>
      <requester>
        <reference value="http://example.org/PractitionerRole/987"/>
        <display value="Dr. Jones"/>
      </requester>
      <note>
        <authorString value="XYZ Insurance"/>
        <time value="2019-02-15T15:07:18-05:00"/>
        <text
              value="Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted.  Please note prior authorization # 12345 on claim submission."/>
      </note>
      <dosageInstruction>
        <text value="6 tablets every 12 hours."/>
        <timing>
          <repeat>
            <frequency value="1"/>
            <period value="12"/>
            <periodUnit value="h"/>
          </repeat>
        </timing>
        <doseAndRate>
          <doseQuantity>
            <value value="6"/>
            <unit value="tablet"/>
          </doseQuantity>
        </doseAndRate>
      </dosageInstruction>
    </MedicationRequest>