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 Information Prior Authorization Value Set

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

Logical Definition (CLD)

  • Include these codes as defined in http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes version 📦2.2.0-ballot
    CodeDisplayDefinition
    no-authNo Prior AuthorizationThe ordered service does not require prior authorization
    auth-neededPrior Authorization NeededThe ordered service will require prior authorization
    satisfiedAuthorization SatisfiedWhile prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed
    performpaPerformer Prior AuthorizationPrior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider.
    conditionalConditionalThere 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

Expansion performed internally based on codesystem Coverage Information Codes v2.2.0-ballot (CodeSystem)

This value set contains 5 concepts

SystemCodeDisplay (en)JSONXML
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes  no-authNo Prior Authorization
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes  auth-neededPrior Authorization Needed
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes  satisfiedAuthorization Satisfied
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes  performpaPerformer Prior Authorization
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes  conditionalConditional

Description of the above table(s).