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

## : Deprecated CRD Coverage Detail Codes Value Set

Page standards status: Deprecated | Maturity Level: 4

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @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 "coverageDetail"] ; #
      fhir:language [ fhir:v "en"] ; #
      fhir:text [
    fhir:status [ fhir:v "extensions" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet coverageDetail</b></p><a name=\"coverageDetail\"> </a><a name=\"hccoverageDetail\"> </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 ?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-allowed-quantity\">allowed-quantity</a></td><td style=\"color: #cccccc\">Maximum quantity</td><td>Indicates limitations on the number of services/products allowed (possibly per time period).  Value should be a Quantity</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-allowed-period\">allowed-period</a></td><td style=\"color: #cccccc\">Maximum allowed period</td><td>Indicates the maximum period of time that can be covered in a single order.  Value should be a Period</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-in-network-copay\">in-network-copay</a></td><td style=\"color: #cccccc\">Copay for in-network</td><td>Indicates a percentage co-pay to expect if delivered in-network.  Value should be a Quantity.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-out-network-copay\">out-network-copay</a></td><td style=\"color: #cccccc\">Copay for out-of-network</td><td>Indicates a percentage co-pay to expect if delivered out-of-network.  Value should be a Quantity.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-concurrent-review\">concurrent-review</a></td><td style=\"color: #cccccc\">Concurrent review</td><td>Additional payer-defined documentation will be required prior to claim payment.  Value should be a boolean.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-appropriate-use-needed\">appropriate-use-needed</a></td><td style=\"color: #cccccc\">Appropriate use</td><td>Payer-defined appropriate use process must be invoked to determine coverage.  Value should be a boolean.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-policy-link\">policy-link</a></td><td style=\"color: #cccccc\">Policy Link</td><td>A URL pointing to the specific portion of a payer policy, coverage agreement or similar authoritative document that provides a portion of the basis for the decision documented in the coverage-information.  Value should be a url.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-instructions\">instructions</a></td><td style=\"color: #cccccc\">Instructions</td><td>Information to display to the user that gives guidance about what steps to take in achieving the recommended actions identified by this coverage-information (e.g. special instructions about requesting authorization, details about information needed, details about data retention, etc.).  Value should be a string.  (Category may vary.)</td></tr></table></li></ul></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:extension ( [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "deprecated"     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-wg>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "fm"     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm>     ] ;
    fhir:value [
    a fhir:Integer ;
    fhir:v 4 ;
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom>         ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd>         ]       ] )     ]
      ] ) ; #
      fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetail"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetail>
      ] ; #
      fhir:identifier ( [
    fhir:system [
    fhir:v "urn:ietf:rfc:3986"^^xsd:anyURI ;
    fhir:l <urn:ietf:rfc:3986>     ] ;
    fhir:value [ fhir:v "urn:oid:2.16.840.1.113883.4.642.40.18.48.12" ]
      ] ) ; #
      fhir:version [ fhir:v "2.2.1"] ; #
      fhir:name [ fhir:v "CRDCoverageDetailCodes"] ; #
      fhir:title [ fhir:v "Deprecated CRD Coverage Detail Codes Value Set"] ; #
      fhir:status [ fhir:v "retired"] ; #
      fhir:experimental [ fhir:v false] ; #
      fhir:date [ fhir:v "2026-03-26T15:54:25+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 for name-value-pair details on a coverage assertion - replaced by the coverageDetailNew value set.  Support for this ValueSet will be dropped in a future version."] ; #
      fhir:jurisdiction ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ;
    fhir:l <urn:iso:std:iso:3166>       ] ;
    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:l <http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp>       ] ;
          ( fhir:concept [
    fhir:code [ fhir:v "allowed-quantity" ]       ] [
    fhir:code [ fhir:v "allowed-period" ]       ] [
    fhir:code [ fhir:v "in-network-copay" ]       ] [
    fhir:code [ fhir:v "out-network-copay" ]       ] [
    fhir:code [ fhir:v "concurrent-review" ]       ] [
    fhir:code [ fhir:v "appropriate-use-needed" ]       ] [
    fhir:code [ fhir:v "policy-link" ]       ] [
    fhir:code [ fhir:v "instructions" ]       ] )     ] )
      ] . #