Da Vinci - Coverage Requirements Discovery
2.2.0-snapshot - STU 2.2 Peer Review

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 2.2.0-snapshot 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

## Example MedicationRequest: MedicationRequest annotated example

Page standards status: Informative

Language: en

> Coverage Information

> > url

> > coverage

> value: Coverage: identifier = Member Number; status = active; type = extended healthcare; dependent = 0; relationship = Self; period = 2011-05-23 --> 2012-05-23

> > url

> > covered

> value: conditional

> > url

> > pa-needed

> value: satisfied

> > url

> > doc-needed

> value: admin

> > url

> > doc-purpose

> value: withclaim

> > url

> > info-needed

> value: performer

> > url

> > billingCode

> value: Current Procedural Terminology (CPT®): 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed)

> > url

> > reason

> value: Prior auth waved due to gold-card status

> category: cat-other

> code: Policy Link

> value: http://example.org/somepayer/policy123.pdf#abc

> qualification: Additional policy details can be found here

> > url

> > detail

> > url

> > questionnaire

> value: `http://example.org/some-payer/Questionnaire/123|1.3.0`

> > url

> > date

> value: 2019-02-15

> > url

> > coverage-assertion-id

> value: 12345ABC

> > url

> > satisfied-pa-id

> value: XXYYZ

> > url

> > contact

> value: Help Desk: http://some-payer.org/xyz-sub-org/get-help-here.html

> > url

> > expiry-date

> value: 2019-08-01

status: Draft

intent: Original Order

medication: mycophenolate mofetil 250 MG Oral Capsule [Cellcept]

subject: Jane Smith

encounter: http://example.org/Encounter/ABC

authoredOn: 2019-02-15

requester: Dr. Jones

note: By XYZ Insurance @2019-02-15 15:07:18-0500

> Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted. Please note prior authorization # 12345 on claim submission.

> dosageInstruction

> text: 6 tablets every 12 hours.

> timing: Once per 12 hours

> ### DoseAndRates

> - | Dose[x]
> * | 6 tablet