Da Vinci - Coverage Requirements Discovery
2.2.0 - STU 2.2 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 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
Standards status: Trial-use Active as of 2026-03-04 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

This value set uses codes slated to be moved from the temporary code system. While this migration did not happen in time to enforce the use of the permanent code system in this release, the codes should appear in the shared Act Reason code system by the summer of 2026, and one of the codes is available now. CRD servers SHOULD start sending the ActReason codes in parallel with the CRD-specific codes once they are available to ease transition in future releases when the CRD value set will be deprecated and eventually retired. §prof-15

Logical Definition (CLD)

  • Include these codes as defined in http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp version 📦2.2.0
    CodeDisplayDefinition
    gold-cardGold cardOrdering Practitioner has been granted 'gold card' status with this payer/coverage type.
    no-member-foundMember not foundThe server was unable to find a matching member or was unable to resolve to a single member, so no coverage information can be provided.
    no-active-coverageCoverage not activeThe referenced coverage for the member was found but is not in force during the relevant time period for which the coverage is being evaluated.
    coverage-not-foundCoverage not foundThe payer is not available to resolve the provided coverage information to an existing coverage record, or it is not specific enough to resolve to a single coverage.
    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 (CodeSystem)

This value set contains 5 concepts

SystemCodeDisplay (en)DefinitionJSONXML
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  gold-cardGold cardOrdering Practitioner has been granted 'gold card' status with this payer/coverage type.
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  no-member-foundMember not foundThe server was unable to find a matching member or was unable to resolve to a single member, so no coverage information can be provided.
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  no-active-coverageCoverage not activeThe referenced coverage for the member was found but is not in force during the relevant time period for which the coverage is being evaluated.
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  coverage-not-foundCoverage not foundThe payer is not available to resolve the provided coverage information to an existing coverage record, or it is not specific enough to resolve to a single coverage.
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  auth-out-networkAuthorization needed out-of-networkAuthorization is necessary if out-of-network.

Description of the above table(s).