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

## ValueSet: CRD Coverage Information Prior Authorization Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/coveragePaDetail | Version: 2.2.1 | Highlight text changes?
Standards status: Trial-use Active as of 2026-03-26 | Maturity Level: 1 | Computable Name: CRDCoveragePaDetail
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.14

Codes defining whether prior auth will be needed for coverage to be provided

References

- CRD Metric Data
- CRD Metric Data
- Coverage Information
- Coverage Information

### Logical Definition (CLD)

- Include these codes as defined in `http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` version 📦2.2.1

  Code | Display | Definition
  no-auth | No Prior Authorization | The ordered service does not require prior authorization
  auth-needed | Prior Authorization Needed | The ordered service will require prior authorization
  satisfied | Authorization Satisfied | While prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed
  performpa | Performer Prior Authorization | Prior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider.
  conditional | Conditional | 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.)
  indeterminate | Indeterminate | Indicates that, due to technical issues on the part of the client and/or server, consent restrictions by the patient, or similar atypical limitations or constraints, the payer is unable to evaluate coverage requirements

### Expansion

Expansion performed internally based on codesystem Coverage Information Codes v2.2.1 (CodeSystem)

This value set contains 6 concepts

System | Code | Display (en) | Definition | JSON | XML
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | no-auth | No Prior Authorization | The ordered service does not require prior authorization |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | auth-needed | Prior Authorization Needed | The ordered service will require prior authorization |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | satisfied | Authorization Satisfied | While prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | performpa | Performer Prior Authorization | Prior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider. |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | conditional | Conditional | 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.) |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | indeterminate | Indeterminate | Indicates that, due to technical issues on the part of the client and/or server, consent restrictions by the patient, or similar atypical limitations or constraints, the payer is unable to evaluate coverage requirements |  |

Description of the above table(s).