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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    {
      "resourceType" : "ValueSet",
      "id" : "coverageAssertionReasons",
      "language" : "en",
      "text" : {
        "status" : "extensions",
        "div" : "<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>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
          "valueInteger" : 1
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
          "valueCode" : "fm"
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
          "valueCode" : "trial-use",
          "_valueCode" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
                "valueCanonical" : "http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"
              }
            ]
          }
        }
      ],
      "url" : "http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons",
      "identifier" : [
        {
          "system" : "urn:ietf:rfc:3986",
          "value" : "urn:oid:2.16.840.1.113883.4.642.40.18.48.10"
        }
      ],
      "version" : "2.2.1",
      "name" : "CRDCoverageAssertionReasons",
      "title" : "CRD Coverage Assertion Reasons Value Set",
      "status" : "active",
      "experimental" : false,
      "date" : "2026-03-26T15:54:25+00:00",
      "publisher" : "HL7 International / Financial Management",
      "contact" : [
        {
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://www.hl7.org/Special/committees/fm"
            }
          ]
        }
      ],
      "description" : "Reasons for a coverage assertion in the coverage-information extension",
      "jurisdiction" : [
        {
          "coding" : [
            {
              "system" : "urn:iso:std:iso:3166",
              "code" : "US"
            }
          ]
        }
      ],
      "compose" : {
        "include" : [
          {
            "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
            "concept" : [
              {
                "code" : "gold-card"
              },
              {
                "code" : "no-member-found"
              },
              {
                "code" : "no-active-coverage"
              },
              {
                "code" : "coverage-not-found"
              },
              {
                "code" : "auth-out-network"
              },
              {
                "code" : "technical"
              }
            ]
          }
        ]
      }
    }