Da Vinci - Coverage Requirements Discovery
​2.2.0-ballot - United States of America flag

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

ValueSet: CRD Coverage Assertion Reasons Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons Version: 2.2.0-ballot
Standards status: Trial-use Active as of 2025-10-30 Maturity Level: 1 Computable Name: CRDCoverageAssertionReasons
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.10

Reasons for a coverage assertion in the coverage-information extension

References

As mentioned in the ballot introduction, this value set uses codes slated to be moved from the temporary code system to a more permanent URL.

Logical Definition (CLD)

  • Include these codes as defined in http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp version 📦2.2.0-ballot
    CodeDisplayDefinition
    gold-cardGold cardOrdering Practitioner has been granted 'gold card' status with this payer/coverage type.
    no-member-foundMember not foundThe CRD service was unable to find a matching member, so no coverage information can be provided
    no-active-coverageCoverage not activeThe referenced insurance coverage for the member is not active, so no coverage information can be provided
    auth-out-networkAuthorization needed out-of-networkAuthorization is necessary if out-of-network.

 

Expansion

Expansion performed internally based on codesystem CRD Temporary Codes v2.2.0-ballot (CodeSystem)

This value set contains 4 concepts

SystemCodeDisplay (en)JSONXML
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  gold-cardGold card
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  no-member-foundMember not found
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  no-active-coverageCoverage not active
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  auth-out-networkAuthorization needed out-of-network

Description of the above table(s).