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/coveragePaDetail | Version: 2.2.0-ballot | |||
| Standards status: Trial-use Active as of 2025-10-30 | Maturity Level: 1 | Computable Name: CRDCoveragePaDetail | ||
| Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.14 | ||||
Codes defining whether prior auth will be needed for coverage to be provided
References
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes version 📦2.2.0-ballot| Code | Display | Definition |
| no-auth | No Prior Authorization | The ordered service does not require prior authorization |
| auth-needed | Prior Authorization Needed | The ordered service will require prior authorization |
| satisfied | Authorization Satisfied | While prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed |
| performpa | Performer Prior Authorization | Prior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider. |
| conditional | Conditional | There is the potential for information requirements from a participant type not listed. However, a decision on whether there in fact are additional information requirements cannot be made without more information (more detailed code, service rendering information, etc.) |
Expansion performed internally based on codesystem Coverage Information Codes v2.2.0-ballot (CodeSystem)
This value set contains 5 concepts
| System | Code | Display (en) | JSON | XML |
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes | no-auth | No Prior Authorization | ||
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes | auth-needed | Prior Authorization Needed | ||
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes | satisfied | Authorization Satisfied | ||
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes | performpa | Performer Prior Authorization | ||
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes | conditional | Conditional |