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" : [
{
"extension" : {
"davinci-crd.associated-resource" : [
{
"reference" : "MedicationRequest/2222"
}
]
},
"uuid" : "urn:uuid:a1c2d18b-bc29-4ce9-be70-f6c26e1d78d8",
"summary" : "Replace order with covered generic?",
"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-req",
"display" : "Required Therapy Alternatives"
}
},
"suggestions" : [
{
"label" : "Change to lower price name brand (selected name brand not covered)",
"actions" : [
{
"type" : "delete",
"description" : "Remove name-brand prescription",
"resourceId" : "MedicationRequest/2222"
},
{
"type" : "create",
"description" : "Add lower-cost alternative",
"resource" : {
"resourceType" : "MedicationRequest",
"id" : "1",
"status" : "draft",
"intent" : "original-order",
"medicationCodeableConcept" : {
"coding" : [
{
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "1790533",
"display" : "Abuse-Deterrent 12 HR oxycodone 9 MG Extended Release Oral Capsule [Xtampza]"
}
]
},
"subject" : {
"reference" : "http://example.org/someEHR/fhir/Patient/123"
},
"encounter" : {
"reference" : "http://example.org/someEHR/fhir/Encounter/987"
},
"authoredOn" : "2015-11-01",
"requester" : {
"reference" : "http://example.org/someEHR/fhir/PractitionerRole/123"
},
"dosageInstruction" : [
{
"text" : "1 10mg tablet, every 12 hours",
"timing" : {
"repeat" : {
"boundsPeriod" : {
"start" : "2015-11-01",
"end" : "2015-11-15"
},
"frequency" : 1,
"period" : 12,
"periodUnit" : "h"
}
},
"doseAndRate" : [
{
"doseQuantity" : {
"value" : 1,
"unit" : "Tablet",
"system" : "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code" : "TAB"
}
}
]
}
],
"dispenseRequest" : {
"numberOfRepeatsAllowed" : 0,
"quantity" : {
"value" : 28,
"unit" : "Tablet",
"system" : "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code" : "TAB"
}
}
}
}
]
}
],
"selectionBehavior" : "any"
},
{
"extension" : {
"davinci-crd.associated-resource" : [
{
"reference" : "MedicationRequest/1111"
}
]
},
"uuid" : "urn:uuid:9cda1f90-48ce-4b1e-abc7-970c65c4bab9",
"summary" : "Liver testing recommended",
"detail" : "Administration of Diclofenac should be accompanied by SGPT monitoring due to potential toxicity",
"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" : "clinical-reminder",
"display" : "Clinical Reminder"
}
},
"suggestions" : [
{
"label" : "Add monthly AST test for 1st 3 months",
"actions" : [
{
"type" : "create",
"description" : "Add order for AST test",
"resource" : {
"resourceType" : "ServiceRequest",
"id" : "1",
"status" : "draft",
"intent" : "original-order",
"category" : [
{
"coding" : [
{
"system" : "http://snomed.info/sct",
"code" : "108252007",
"display" : "Laboratory procedure"
}
]
}
],
"code" : {
"coding" : [
{
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "80076",
"display" : "Hepatic function panel"
}
]
},
"subject" : {
"reference" : "http://example.org/fhir/Patient/123",
"display" : "Jane Smith"
},
"encounter" : {
"reference" : "http://example.org/fhir/Encounter/ABC"
},
"occurrenceTiming" : {
"repeat" : {
"boundsDuration" : {
"value" : 3,
"unit" : "months",
"system" : "http://unitsofmeasure.org",
"code" : "mo"
},
"frequency" : 1,
"period" : 1,
"periodUnit" : "mo"
}
},
"authoredOn" : "2019-02-15",
"requester" : {
"reference" : "http://example.org/fhir/PractitionerRole/987",
"display" : "Dr. Jones"
}
}
}
]
}
],
"selectionBehavior" : "any"
},
{
"extension" : {
"davinci-crd.associated-resource" : [
{
"reference" : "MedicationRequest/2222"
}
]
},
"uuid" : "urn:uuid:ba18576a-1905-4e2c-b5fd-cf04171dc291",
"summary" : "Complete Opiod Use form",
"detail" : "Form ABC is required to attest to appropriate opiod usage",
"indicator" : "info",
"source" : {
"label" : "Centers for Medicare & Medicaid Services",
"url" : "https://example.org/cms",
"topic" : {
"system" : "http://example.org/fhir/CodeSystem/SomeCodes",
"code" : "123",
"display" : "Regulatory Requirement"
}
},
"suggestions" : [
{
"label" : "Add 'completion of the ABC form' to your task list (possibly for reassignment)",
"actions" : [
{
"extension" : {
"string" : [
"url=http://example.org/Questionnaire/XYZ&version=2"
]
},
"type" : "create",
"description" : "Add version 2 of the XYZ form to the clinical system's repository (if it doesn't already exist)",
"resource" : {
"resourceType" : "Questionnaire",
"id" : "1",
"url" : "http://example.org/Questionnaire/XYZ",
"version" : "2",
"status" : "active",
"item" : [
{
"linkId" : "1",
"text" : "Has the patient previously tried non-opioid therapy and been unsuccessful?",
"type" : "boolean"
}
]
}
},
{
"type" : "create",
"description" : "Add 'Complete ABC form' to the task list",
"resource" : {
"resourceType" : "Task",
"id" : "1",
"basedOn" : [
{
"reference" : "http://example.org/fhir/Appointment/27"
}
],
"status" : "ready",
"intent" : "order",
"code" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/uv/sdc/CodeSystem/temp",
"code" : "complete-questionnaire"
}
]
},
"description" : "Complete XYZ form for local retention",
"for" : {
"reference" : "http://example.org/fhir/Patient/123"
},
"authoredOn" : "2018-08-09",
"requester" : {
"reference" : "http://example.org/fhir/Practitioner/987"
},
"input" : [
{
"type" : {
"text" : "questionnaire"
},
"valueCanonical" : "http://example.org/Questionnaire/XYZ|2"
},
{
"type" : {
"text" : "afterCompletion"
},
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://example.org/fhir/CodeSystem/SomeCodes",
"code" : "987",
"display" : "Local Use"
}
]
}
}
]
}
}
]
}
],
"selectionBehavior" : "any"
},
{
"uuid" : "urn:uuid:5561ec1e-78c5-48aa-8fc0-037c476452bf",
"summary" : "Patient coverage information is incomplete",
"indicator" : "info",
"source" : {
"label" : "Some Payer",
"url" : "https://example.org",
"icon" : "https://example.org/img/icon-100px.png",
"topic" : {
"system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"code" : "insurance",
"display" : "Insurance"
}
},
"suggestions" : [
{
"label" : "Update coverage information to be current",
"uuid" : "urn:uuid:1207df9d-9ff6-4042-985b-b8dec21038c2",
"actions" : [
{
"type" : "update",
"description" : "Update current coverage record",
"resource" : {
"resourceType" : "Coverage",
"id" : "1234",
"status" : "active",
"subscriberId" : "192837",
"beneficiary" : {
"reference" : "http://example.org/fhir/Patient/123"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"period" : {
"start" : "2023-01-01",
"end" : "2023-11-30"
},
"payor" : [
{
"reference" : "http://example.org/fhir/Organization/ABC"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "group"
}
]
},
"value" : "A1"
}
]
}
}
]
}
],
"selectionBehavior" : "any"
},
{
"extension" : {
"davinci-crd.associated-resource" : [
{
"reference" : "MedicationRequest/2222"
}
]
},
"uuid" : "urn:uuid:353cd963-2ecd-46f9-958b-ed7d2bbf6e01",
"summary" : "Launch opioid XYZ-assessment",
"indicator" : "info",
"source" : {
"label" : "Some Payer",
"url" : "https://example.org",
"icon" : "https://example.org/img/icon-100px.png",
"topic" : {
"system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
"code" : "guideline",
"display" : "Guideline"
}
},
"links" : [
{
"label" : "Opioid XYZ-assessment",
"url" : "https://example.org/opioid-assessment",
"type" : "smart",
"appContext" : "{\"payerXYZQNum\":\"205f471f-f408-45d4-9213-0eedf95f417f\"}"
}
]
}
]
}
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
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change