Da Vinci - Coverage Requirements Discovery
2.2.0-ballot -
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
| 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.
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp version 📦2.2.0-ballot| Code | Display | Definition |
| allowed-quantity | Maximum quantity | Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity |
| allowed-period | Maximum allowed period | Indicates the maximum period of time that can be covered in a single order. Value should be a Period |
| in-network-copay | Copay for in-network | Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity. |
| out-network-copay | Copay for out-of-network | Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity. |
| concurrent-review | Concurrent review | Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean. |
| appropriate-use-needed | Appropriate use | Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean. |
| policy-link | Policy Link | A 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. |
| instructions | Instructions | Information 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 performed internally based on codesystem CRD Temporary Codes v2.2.0-ballot (CodeSystem)
This value set contains 8 concepts
| System | Code | Display (en) | JSON | XML |
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | allowed-quantity | Maximum quantity | ||
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | allowed-period | Maximum allowed period | ||
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | in-network-copay | Copay for in-network | ||
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | out-network-copay | Copay for out-of-network | ||
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | concurrent-review | Concurrent review | ||
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | appropriate-use-needed | Appropriate use | ||
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | policy-link | Policy Link | ||
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | instructions | Instructions |