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 Assertion Reasons Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons | Version: 2.2.1 | Highlight text changes?
Standards status: Trial-use Active as of 2026-03-26 | Maturity Level: 1 | Computable Name: CRDCoverageAssertionReasons
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.10

Reasons for a coverage assertion in the coverage-information extension

References

- Coverage Information
- Coverage Information

> This value set uses codes slated to be moved from the temporary code system. While this migration did not happen in time to enforce the use of the permanent code system in this release, the codes should appear in the shared Act Reason code system by the summer of 2026, and one of the codes is available now. CRD servers SHOULD start sending the ActReason codes in parallel with the CRD-specific codes once they are available to ease transition in future releases when the CRD value set will be deprecated and eventually retired. §prof-15

### Logical Definition (CLD)

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

  Code | Display | Definition
  gold-card | Gold card | Ordering Practitioner has been granted 'gold card' status with this payer/coverage type.
  no-member-found | Member not found | 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.
  no-active-coverage | Coverage not active | 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.
  coverage-not-found | Coverage not found | 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.
  auth-out-network | Authorization needed out-of-network | Authorization is necessary if out-of-network.
  technical | Technical issues | 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.

### Expansion

Expansion performed internally based on codesystem CRD Temporary 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/temp` | gold-card | Gold card | Ordering Practitioner has been granted 'gold card' status with this payer/coverage type. |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp` | no-member-found | Member not found | 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. |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp` | no-active-coverage | Coverage not active | 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. |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp` | coverage-not-found | Coverage not found | 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. |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp` | auth-out-network | Authorization needed out-of-network | Authorization is necessary if out-of-network. |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp` | technical | Technical issues | 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. |  |

Description of the above table(s).