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: Official CRD Coverage Detail Codes Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetailNew Version: 2.2.0
Standards status: Trial-use Active as of 2026-03-04 Maturity Level: 4 Computable Name: CRDCoverageDetailCodesNew
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.26

Codes for name-value-pair details on a coverage assertion - now using official FHIR codes

References

Logical Definition (CLD)

 

Expansion

Expansion performed internally based on codesystem CRD Coverage Detail Codes v1.0.0 (CodeSystem)

This value set contains 11 concepts

LevelSystemCodeDisplay (en)DefinitionJSONXML
1http://terminology.hl7.org/CodeSystem/crd-coverage-detail  _limitationLimitation detailsIdentifies detail codes that define limitations of coverage. (Category should be 'cat-limitation')
2http://terminology.hl7.org/CodeSystem/crd-coverage-detail    allowed-quantityMaximum quantityIndicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity
2http://terminology.hl7.org/CodeSystem/crd-coverage-detail    allowed-periodMaximum allowed periodIndicates the maximum period of time that can be covered in a single order. Value should be a Period
1http://terminology.hl7.org/CodeSystem/crd-coverage-detail  _decisionalDecisional detailsIdentifies detail codes that may impact patient and clinician decision making (Category should be 'cat-decisional')
2http://terminology.hl7.org/CodeSystem/crd-coverage-detail    in-network-copayCopay for in-networkIndicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity.
2http://terminology.hl7.org/CodeSystem/crd-coverage-detail    out-network-copayCopay for out-of-networkIndicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity.
2http://terminology.hl7.org/CodeSystem/crd-coverage-detail    concurrent-reviewConcurrent reviewAdditional payer-defined documentation will be required prior to claim payment. Value should be a boolean.
2http://terminology.hl7.org/CodeSystem/crd-coverage-detail    appropriate-use-neededAppropriate usePayer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean.
1http://terminology.hl7.org/CodeSystem/crd-coverage-detail  _otherOther detailsIdentifies detail codes that are generally not relevant to clinicians/patients (Category should be 'cat-other')
2http://terminology.hl7.org/CodeSystem/crd-coverage-detail    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.
1http://terminology.hl7.org/CodeSystem/crd-coverage-detail  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.)

Description of the above table(s).