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

## ValueSet: CRD Information Needed Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/informationNeeded | Version: 2.2.0-snapshot | Highlight text changes?
Standards status: Trial-use Active as of 2026-02-19 | Maturity Level: 1 | Computable Name: CRDInformationNeeded
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.16

Codes defining whether information about the performer, location, and/or performance date is needed to determine coverage information

References

- CRD Metric Data
- Coverage Information

### Logical Definition (CLD)

This value set includes codes based on the following rules:

- Include these codes as defined in `http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` version 📦2.2.0-snapshot

  Code | Display | Definition
  performer | Performer Needed | Information about who (specifically, or at least performer type and affiliation) is necessary to make a determination of coverage and/or prior auth expectations
  location | Location Needed | Information about where (specific clinic/site or organization) is necessary to make a determination of coverage and/or prior auth expectations
  timeframe | Timeframe Needed | Information about when the service will be performed that is more granular than the order effective period is necessary to make a determination of coverage and/or prior auth expectations
  contract-window | New Contract Window | The target performance time for the event falls outside the contract window for the patient's current coverage. Information will not be available until a contract is in place covering the service time period
  detail-code | Detail code | The ordered code is at too high a level of granularity to make decisions about coverage/pa/etc. Can only be present if something is 'conditional'

- Include these codes as defined in `http://terminology.hl7.org/CodeSystem/v3-NullFlavor` version 📍3.0.0

  Code | Display | Definition
  OTH | other | **Description:**The actual value is not a member of the set of permitted data values in the constrained value domain of a variable. (e.g., concept not provided by required code system). **Usage Notes**: This flavor and its specializations are most commonly used with the CD datatype and its flavors. However, it may apply to \*any\* datatype where the constraints of the type are tighter than can be conveyed. For example, a PQ that is for a true measured amount whose units are not supported in UCUM, a need to convey a REAL when the type has been constrained to INT, etc. With coded datatypes, this null flavor may only be used if the vocabulary binding has a coding strength of CNE. By definition, all local codes and original text are part of the value set if the coding strength is CWE.

### Expansion

Expansion performed internally based on:

- codesystem Coverage Information Codes v2.2.0-snapshot (CodeSystem)
- codesystem NullFlavor v3.0.0 (CodeSystem)

This value set contains 6 concepts

System | Code | Display (en) | Definition | JSON | XML
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | performer | Performer Needed | Information about who (specifically, or at least performer type and affiliation) is necessary to make a determination of coverage and/or prior auth expectations |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | location | Location Needed | Information about where (specific clinic/site or organization) is necessary to make a determination of coverage and/or prior auth expectations |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | timeframe | Timeframe Needed | Information about when the service will be performed that is more granular than the order effective period is necessary to make a determination of coverage and/or prior auth expectations |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | contract-window | New Contract Window | The target performance time for the event falls outside the contract window for the patient's current coverage. Information will not be available until a contract is in place covering the service time period |  |
`http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes` | detail-code | Detail code | The ordered code is at too high a level of granularity to make decisions about coverage/pa/etc. Can only be present if something is 'conditional' |  |
`http://terminology.hl7.org/CodeSystem/v3-NullFlavor` | OTH | other | **Description:**The actual value is not a member of the set of permitted data values in the constrained value domain of a variable. (e.g., concept not provided by required code system). Usage Notes: This flavor and its specializations are most commonly used with the CD datatype and its flavors. However, it may apply to *any* datatype where the constraints of the type are tighter than can be conveyed. For example, a PQ that is for a true measured amount whose units are not supported in UCUM, a need to convey a REAL when the type has been constrained to INT, etc. With coded datatypes, this null flavor may only be used if the vocabulary binding has a coding strength of CNE. By definition, all local codes and original text are part of the value set if the coding strength is CWE. |  |

Description of the above table(s).