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-ballot 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
{
"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're Covered Insurance",
"url" : "https://example.org",
"icon" : "https://example.org/img/icon-100px.png",
"topic" : {
"system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"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://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"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://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"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",
"valueContactPoint" : {
"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"
}
}
}
]
}
IG © 2019+ HL7 International / Financial Management.
Package hl7.fhir.us.davinci-crd#2.2.0-ballot based on FHIR 4.0.1.
Generated 2025-10-30
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