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

Instance of logical model CRD CDSHooks Response (Logical Definition)

## Binary: Example CRD Response with: Links, Information, Coverage Information, and Order Replacement example

    {
      "cards" : [
        {
          "uuid" : "urn:uuid:fbc9e223-4ba8-4bb9-a31c-4720c14f00d2",
          "summary" : "Patient is overdue for a PAP smear",
          "detail" : "Last date on record for a PAP test for this patient was May, 2014.  Tests should ideally be performed every 1-3 years",
          "indicator" : "info",
          "source" : {
            "label" : "You are Covered Insurance",
            "url" : "https://example.org",
            "icon" : "https://example.org/img/icon-100px.png",
            "topic" : {
              "system" : "http://terminology.hl7.org/CodeSystem/cdshooks-card-type",
              "code" : "clinical-reminder",
              "display" : "Clinical Reminder"
            }
          }
        },
        {
          "extension" : {
            "davinci-crd.associated-resource" : [
              {
                "reference" : "ServiceRequest/2468"
              }
            ]
          },
          "uuid" : "urn:uuid:07bc9814-9d2a-11ee-8c90-0242ac120002",
          "summary" : "CMS Home Oxygen Therapy Coverage Requirements",
          "detail" : "Learn about covered oxygen items and equipment for home use; coverage requirements; criteria you must meet to furnish oxygen items and equipment for home use; Advance Beneficiary Notice of Noncoverage; oxygen equipment, items, and services that are not covered; and payments for oxygen items and equipment and billing and coding guidelines.",
          "indicator" : "info",
          "source" : {
            "label" : "Centers for Medicare & Medicaid Services",
            "url" : "https://example.org/cms",
            "topic" : {
              "system" : "http://terminology.hl7.org/CodeSystem/cdshooks-card-type",
              "code" : "guideline",
              "display" : "Guideline"
            }
          },
          "links" : [
            {
              "label" : "Home Oxygen Therapy Guidelines",
              "url" : "https://example.org/cms/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Home-Oxygen-Therapy-ICN908804.pdf",
              "type" : "absolute"
            },
            {
              "label" : "Home Oxygen Therapy Guidelines (printer-friendly)",
              "url" : "https://example.org/cms/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Home-Oxygen-Therapy-Text-Only.pdf",
              "type" : "absolute"
            }
          ]
        },
        {
          "extension" : {
            "davinci-crd.associated-resource" : [
              {
                "reference" : "ServiceRequest/2468"
              }
            ]
          },
          "uuid" : "urn:uuid:0941cda0-91d7-42db-b5af-0ebbef2507bf",
          "summary" : "Replace rental order with purchase order (to reduce long-term costs)",
          "detail" : "Mrs. Baxter has been on home oxygen for over 18 months and purchase is more efficient.  Payer XYZ has negotiated a discount on Acme brand portable oxygen systems which will result in a cost only slightly higher than annual rental",
          "indicator" : "info",
          "source" : {
            "label" : "Centers for Medicare & Medicaid Services",
            "url" : "https://example.org/cms",
            "topic" : {
              "system" : "http://terminology.hl7.org/CodeSystem/cdshooks-card-type",
              "code" : "therapy-alternatives-opt",
              "display" : "Optional Therapy Alternatives"
            }
          },
          "suggestions" : [
            {
              "label" : "Change to an order for purchase",
              "actions" : [
                {
                  "type" : "delete",
                  "description" : "Remove rental order",
                  "resourceId" : "ServiceRequest/2468"
                },
                {
                  "type" : "create",
                  "description" : "Add purchase order",
                  "resource" : {
                    "resourceType" : "ServiceRequest",
                    "id" : "AAA",
                    "text" : {
                      "status" : "generated",
                      "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing for Amy V. Baxter<br/>Requested by Dr. Jones, Feb 15, 2019</div>"
                    },
                    "status" : "draft",
                    "intent" : "original-order",
                    "code" : {
                      "coding" : [
                        {
                          "system" : "https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets",
                          "code" : "E0430",
                          "display" : "Portable gaseous oxygen system, purchase; includes regulator, flowmeter, humidifier, cannula or mask, and tubing"
                        }
                      ]
                    },
                    "subject" : {
                      "reference" : "http://example.org/fhir/Patient/123"
                    },
                    "encounter" : {
                      "reference" : "http://example.org/fhir/Encounter/987"
                    },
                    "authoredOn" : "2019-02-15",
                    "requester" : {
                      "reference" : "http://example.org/fhir/PractitionerRole/ABC",
                      "display" : "Dr. Jones"
                    }
                  }
                },
                {
                  "type" : "create",
                  "description" : "Add specific (discounted) device order",
                  "resource" : {
                    "resourceType" : "DeviceRequest",
                    "id" : "BBB",
                    "text" : {
                      "status" : "generated",
                      "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Order for Acme ZZZ portable gaseous oxygen system for Amy V. Baxter<br/>Requested by Dr. Jones, Feb 15, 2019</div>"
                    },
                    "basedOn" : [
                      {
                        "reference" : "http://example.org/ServiceRequest/AAA"
                      }
                    ],
                    "status" : "draft",
                    "intent" : "original-order",
                    "codeCodeableConcept" : {
                      "coding" : [
                        {
                          "system" : "https://example.org/some-organization/device-codes",
                          "code" : "ZZZ",
                          "display" : "Acme ZZZ Portable gaseous oxygen system"
                        }
                      ]
                    },
                    "subject" : {
                      "reference" : "http://example.org/fhir/Patient/123"
                    },
                    "encounter" : {
                      "reference" : "http://example.org/fhir/Encounter/987"
                    },
                    "authoredOn" : "2019-02-15",
                    "requester" : {
                      "reference" : "http://example.org/fhir/PractitionerRole/ABC",
                      "display" : "Dr. Jones"
                    }
                  }
                }
              ]
            }
          ],
          "selectionBehavior" : "any"
        }
      ],
      "systemActions" : [
        {
          "type" : "update",
          "resource" : {
            "resourceType" : "ServiceRequest",
            "id" : "idfromcontext",
            "extension" : [
              {
                "extension" : [
                  {
                    "url" : "coverage",
                    "valueReference" : {
                      "reference" : "http://example.org/fhir/Coverage/example"
                    }
                  },
                  {
                    "url" : "covered",
                    "valueCode" : "covered"
                  },
                  {
                    "url" : "pa-needed",
                    "valueCode" : "satisfied"
                  },
                  {
                    "url" : "doc-needed",
                    "valueCode" : "conditional"
                  },
                  {
                    "url" : "info-needed",
                    "valueCode" : "OTH"
                  },
                  {
                    "url" : "billingCode",
                    "valueCoding" : {
                      "system" : "http://www.ama-assn.org/go/cpt",
                      "code" : "77065"
                    }
                  },
                  {
                    "url" : "billingCode",
                    "valueCoding" : {
                      "system" : "http://www.ama-assn.org/go/cpt",
                      "code" : "77066"
                    }
                  },
                  {
                    "url" : "billingCode",
                    "valueCoding" : {
                      "system" : "http://www.ama-assn.org/go/cpt",
                      "code" : "77067"
                    }
                  },
                  {
                    "url" : "reason",
                    "valueCodeableConcept" : {
                      "coding" : [
                        {
                          "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
                          "code" : "auth-out-network",
                          "display" : "Authorization needed out-of-network"
                        }
                      ],
                      "text" : "In-network required unless exigent circumstances"
                    }
                  },
                  {
                    "url" : "reason",
                    "valueCodeableConcept" : {
                      "text" : "Diagnosis needed to determine documentation requirements"
                    }
                  },
                  {
                    "extension" : [
                      {
                        "url" : "category",
                        "valueCode" : "cat-limitation"
                      },
                      {
                        "url" : "code",
                        "valueCodeableConcept" : {
                          "coding" : [
                            {
                              "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
                              "code" : "out-network-copay"
                            }
                          ]
                        }
                      },
                      {
                        "url" : "value",
                        "valueQuantity" : {
                          "value" : 10,
                          "system" : "http://unitsofmeasure.org",
                          "code" : "%"
                        }
                      },
                      {
                        "url" : "qualification",
                        "valueString" : "Copay minimum is $15"
                      }
                    ],
                    "url" : "detail"
                  },
                  {
                    "url" : "dependency",
                    "valueReference" : {
                      "reference" : "http://example.org/fhir/ServiceRequest/example2"
                    }
                  },
                  {
                    "url" : "date",
                    "valueDate" : "2019-02-15"
                  },
                  {
                    "url" : "coverage-assertion-id",
                    "valueString" : "12345ABC"
                  },
                  {
                    "url" : "satisfied-pa-id",
                    "valueString" : "Q8U119"
                  },
                  {
                    "url" : "contact",
                    "valueContactDetail" : {
                      "telecom" : [
                        {
                          "system" : "url",
                          "value" : "http://some-payer/xyz-sub-org/get-help-here.html"
                        }
                      ]
                    }
                  }
                ],
                "url" : "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"
              }
            ],
            "status" : "draft",
            "intent" : "original-order",
            "code" : {
              "coding" : [
                {
                  "system" : "http://snomed.info/sct",
                  "code" : "726551006",
                  "display" : "Contrast enhanced spectral mammography (Procedure)"
                }
              ]
            },
            "subject" : {
              "reference" : "http://example.org/fhir/Patient/123",
              "display" : "Jane Smith"
            },
            "encounter" : {
              "reference" : "http://example.org/fhir/Encounter/987"
            },
            "authoredOn" : "2019-02-15",
            "requester" : {
              "reference" : "http://example.org/fhir/PractitionerRole/ABC",
              "display" : "Dr. Jones"
            }
          }
        }
      ]
    }