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 Detail Codes Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetail Version: 2.2.0-ballot
Standards status: Trial-use Active as of 2025-10-30 Maturity Level: 4 Computable Name: CRDCoverageDetailCodes
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.12

Codes for name-value-pair details on a coverage assertion

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
    allowed-quantityMaximum quantityIndicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity
    allowed-periodMaximum allowed periodIndicates the maximum period of time that can be covered in a single order. Value should be a Period
    in-network-copayCopay for in-networkIndicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity.
    out-network-copayCopay for out-of-networkIndicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity.
    concurrent-reviewConcurrent reviewAdditional payer-defined documentation will be required prior to claim payment. Value should be a boolean.
    appropriate-use-neededAppropriate usePayer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean.
    policy-linkPolicy LinkA URL pointing to the specific portion of a payer policy, coverage agreement or similar authoritative document that provides a portion of the basis for the decision documented in the coverage-information. Value should be a url.
    instructionsInstructionsInformation to display to the user that gives guidance about what steps to take in achieving the recommended actions identified by this coverage-information (e.g. special instructions about requesting authorization, details about information needed, details about data retention, etc.). Value should be a string. (Category may vary.)

 

Expansion

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

This value set contains 8 concepts

SystemCodeDisplay (en)JSONXML
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  allowed-quantityMaximum quantity
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  allowed-periodMaximum allowed period
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  in-network-copayCopay for in-network
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  out-network-copayCopay for out-of-network
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  concurrent-reviewConcurrent review
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  appropriate-use-neededAppropriate use
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  policy-linkPolicy Link
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp  instructionsInstructions

Description of the above table(s).