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

## : CRD Coverage Information Prior Authorization Value Set

Page standards status: Trial-use | Maturity Level: 1

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    <ValueSet xmlns="http://hl7.org/fhir">
      <id value="coveragePaDetail"/>
      <language value="en"/>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ValueSet coveragePaDetail</b></p><a name="coveragePaDetail"> </a><a name="hccoveragePaDetail"> </a><ul><li>Include these codes as defined in <a href="CodeSystem-coverage-information-codes.html"><code>http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes</code></a><span title="Version is not explicitly stated, which means it is fixed to the version provided in this specification"> version &#x1F4E6;2.2.0-snapshot</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-coverage-information-codes.html#coverage-information-codes-no-auth">no-auth</a></td><td style="color: #cccccc">No Prior Authorization</td><td>The ordered service does not require prior authorization</td></tr><tr><td><a href="CodeSystem-coverage-information-codes.html#coverage-information-codes-auth-needed">auth-needed</a></td><td style="color: #cccccc">Prior Authorization Needed</td><td>The ordered service will require prior authorization</td></tr><tr><td><a href="CodeSystem-coverage-information-codes.html#coverage-information-codes-satisfied">satisfied</a></td><td style="color: #cccccc">Authorization Satisfied</td><td>While prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed</td></tr><tr><td><a href="CodeSystem-coverage-information-codes.html#coverage-information-codes-performpa">performpa</a></td><td style="color: #cccccc">Performer Prior Authorization</td><td>Prior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider.</td></tr><tr><td><a href="CodeSystem-coverage-information-codes.html#coverage-information-codes-conditional">conditional</a></td><td style="color: #cccccc">Conditional</td><td>There is the potential for information requirements from a participant type not listed.  However, a decision on whether there in fact are additional information requirements cannot be made without more information (more detailed code, service rendering information, etc.)</td></tr></table></li></ul></div>
      </text>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
        <valueInteger value="1"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
        <valueCode value="fm"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
        <valueCode value="trial-use">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
            <valueCanonical
                            value="http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"/>
          </extension>
        </valueCode>
      </extension>
      <url value="http://hl7.org/fhir/us/davinci-crd/ValueSet/coveragePaDetail"/>
      <identifier>
        <system value="urn:ietf:rfc:3986"/>
        <value value="urn:oid:2.16.840.1.113883.4.642.40.18.48.14"/>
      </identifier>
      <version value="2.2.0-snapshot"/>
      <name value="CRDCoveragePaDetail"/>
      <title value="CRD Coverage Information Prior Authorization Value Set"/>
      <status value="active"/>
      <experimental value="false"/>
      <date value="2026-02-19T15:54:35+00:00"/>
      <publisher value="HL7 International / Financial Management"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org/Special/committees/fm"/>
        </telecom>
      </contact>
      <description
                   value="Codes defining whether prior auth will be needed for coverage to be provided"/>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="US"/>
        </coding>
      </jurisdiction>
      <compose>
        <include>
          <system
                  value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes"/>
          <concept>
            <code value="no-auth"/>
          </concept>
          <concept>
            <code value="auth-needed"/>
          </concept>
          <concept>
            <code value="satisfied"/>
          </concept>
          <concept>
            <code value="performpa"/>
          </concept>
          <concept>
            <code value="conditional"/>
          </concept>
        </include>
      </compose>
    </ValueSet>