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

## : MedicationRequest annotated example

Page standards status: Informative

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    {
      "resourceType" : "MedicationRequest",
      "id" : "annotated-example",
      "language" : "en",
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: MedicationRequest annotated-example</b></p><a name=\"annotated-example\"> </a><a name=\"hcannotated-example\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Language: en</p></div><blockquote><p><b>Coverage Information</b></p><blockquote><p><b>url</b></p>coverage</blockquote><p><b>value</b>: <a href=\"Coverage-example.html\">Coverage: identifier = Member Number; status = active; type = extended healthcare; dependent = 0; relationship = Self; period = 2011-05-23 --&gt; 2012-05-23</a></p><blockquote><p><b>url</b></p>covered</blockquote><p><b>value</b>: conditional</p><blockquote><p><b>url</b></p>pa-needed</blockquote><p><b>value</b>: satisfied</p><blockquote><p><b>url</b></p>doc-needed</blockquote><p><b>value</b>: admin</p><blockquote><p><b>url</b></p>doc-purpose</blockquote><p><b>value</b>: withclaim</p><blockquote><p><b>url</b></p>info-needed</blockquote><p><b>value</b>: performer</p><blockquote><p><b>url</b></p>billingCode</blockquote><p><b>value</b>: <a href=\"http://terminology.hl7.org/6.2.0/CodeSystem-CPT.html#CPT-77067\">Current Procedural Terminology (CPT®): 77067</a> (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed)</p><blockquote><p><b>url</b></p>reason</blockquote><p><b>value</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp gold-card}\">Prior auth waved due to gold-card status</span></p><p><b>category</b>: cat-other</p><p><b>code</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp policy-link}\">Policy Link</span></p><p><b>value</b>: <a href=\"http://example.org/somepayer/policy123.pdf#abc\">http://example.org/somepayer/policy123.pdf#abc</a></p><p><b>qualification</b>: Additional policy details can be found here</p><blockquote><p><b>url</b></p>detail</blockquote><blockquote><p><b>url</b></p>questionnaire</blockquote><p><b>value</b>: <code>http://example.org/some-payer/Questionnaire/123|1.3.0</code></p><blockquote><p><b>url</b></p><a href=\"http://hl7.org/fhir/R4/datatypes.html#date\">date</a></blockquote><p><b>value</b>: 2019-02-15</p><blockquote><p><b>url</b></p>coverage-assertion-id</blockquote><p><b>value</b>: 12345ABC</p><blockquote><p><b>url</b></p>satisfied-pa-id</blockquote><p><b>value</b>: XXYYZ</p><blockquote><p><b>url</b></p>contact</blockquote><p><b>value</b>: Help Desk: <a href=\"http://some-payer.org/xyz-sub-org/get-help-here.html\">http://some-payer.org/xyz-sub-org/get-help-here.html</a></p><blockquote><p><b>url</b></p>expiry-date</blockquote><p><b>value</b>: 2019-08-01</p></blockquote><p><b>status</b>: Draft</p><p><b>intent</b>: Original Order</p><p><b>medication</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 616447}\">mycophenolate mofetil 250 MG Oral Capsule [Cellcept]</span></p><p><b>subject</b>: <a href=\"http://example.org/Patient/123\">Jane Smith</a></p><p><b>encounter</b>: <a href=\"http://example.org/Encounter/ABC\">http://example.org/Encounter/ABC</a></p><p><b>authoredOn</b>: 2019-02-15</p><p><b>requester</b>: <a href=\"http://example.org/PractitionerRole/987\">Dr. Jones</a></p><p><b>note</b>: By XYZ Insurance @2019-02-15 15:07:18-0500</p><blockquote><div><p>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.</p>\n</div></blockquote><blockquote><p><b>dosageInstruction</b></p><p><b>text</b>: 6 tablets every 12 hours.</p><p><b>timing</b>: Once per 12 hours</p><h3>DoseAndRates</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Dose[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>6 tablet</td></tr></table></blockquote></div>"
      },
      "extension" : [
        {
          "extension" : [
            {
              "url" : "coverage",
              "valueReference" : {
                🔗 "reference" : "Coverage/example"
              }
            },
            {
              "url" : "covered",
              "valueCode" : "conditional"
            },
            {
              "url" : "pa-needed",
              "valueCode" : "satisfied"
            },
            {
              "url" : "doc-needed",
              "valueCode" : "admin"
            },
            {
              "url" : "doc-purpose",
              "valueCode" : "withclaim"
            },
            {
              "url" : "info-needed",
              "valueCode" : "performer"
            },
            {
              "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" : "gold-card"
                  }
                ],
                "text" : "Prior auth waved due to gold-card status"
              }
            },
            {
              "extension" : [
                {
                  "url" : "category",
                  "valueCode" : "cat-other"
                },
                {
                  "url" : "code",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
                        "code" : "policy-link"
                      }
                    ]
                  }
                },
                {
                  "url" : "value",
                  "valueUrl" : "http://example.org/somepayer/policy123.pdf#abc"
                },
                {
                  "url" : "qualification",
                  "valueString" : "Additional policy details can be found here"
                }
              ],
              "url" : "detail"
            },
            {
              "url" : "questionnaire",
              "valueCanonical" : "http://example.org/some-payer/Questionnaire/123|1.3.0"
            },
            {
              "url" : "date",
              "valueDate" : "2019-02-15"
            },
            {
              "url" : "coverage-assertion-id",
              "valueString" : "12345ABC"
            },
            {
              "url" : "satisfied-pa-id",
              "valueString" : "XXYYZ"
            },
            {
              "url" : "contact",
              "valueContactDetail" : {
                "name" : "Help Desk",
                "telecom" : [
                  {
                    "system" : "url",
                    "value" : "http://some-payer.org/xyz-sub-org/get-help-here.html"
                  }
                ]
              }
            },
            {
              "url" : "expiry-date",
              "valueDate" : "2019-08-01"
            }
          ],
          "url" : "http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"
        }
      ],
      "status" : "draft",
      "intent" : "original-order",
      "medicationCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
            "code" : "616447",
            "display" : "mycophenolate mofetil 250 MG Oral Capsule [Cellcept]"
          }
        ]
      },
      "subject" : {
        "reference" : "http://example.org/Patient/123",
        "display" : "Jane Smith"
      },
      "encounter" : {
        "reference" : "http://example.org/Encounter/ABC"
      },
      "authoredOn" : "2019-02-15",
      "requester" : {
        "reference" : "http://example.org/PractitionerRole/987",
        "display" : "Dr. Jones"
      },
      "note" : [
        {
          "authorString" : "XYZ Insurance",
          "time" : "2019-02-15T15:07:18-05:00",
          "text" : "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" : {
            "repeat" : {
              "frequency" : 1,
              "period" : 12,
              "periodUnit" : "h"
            }
          },
          "doseAndRate" : [
            {
              "doseQuantity" : {
                "value" : 6,
                "unit" : "tablet"
              }
            }
          ]
        }
      ]
    }