Da Vinci - Coverage Requirements Discovery
1.1.0-ballot - STU 1.1 US

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v1.1.0-ballot: STU 1.1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

CodeSystem: CRD Card Types Code System

Official URL: http://hl7.org/fhir/us/davinci-crd/CodeSystem/cardType Version: 1.1.0-ballot
Draft as of 2022-02-17 Computable Name: CardType

List of card types

This Code system is referenced in the content logical definition of the following value sets:

This code system http://hl7.org/fhir/us/davinci-crd/CodeSystem/cardType defines the following codes:

CodeDisplayDefinition
coverage CoverageIs the therapy covered or not, or are there limitations
documentation DocumentationAre there additional documentation requirements
prior-auth Prior AuthorizationIs prior authorization required or not (and possibly provision of unsolicited prior authorizations)
dtr-clin DTR ClinIndication that DTR is relevant for prior authorization, claim or other documentation requirements and that at least some clinical information needs to be captured
dtr-admin DTR AdminIndication that DTR is relevant for prior authorization, claim or other documentation requirements and that all information to be captured is strictly administrative (and thus it is not necessary that the app be launched by the ordering clinician)
claim ClaimInformation about what steps need to be taken to submit a claim for the service
insurance InsuranceAllows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)
limits LimitsMessages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general
network NetworkProviding information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)
appropriate-use Appropriate UseGuidance on whether appropriate-use documentation is needed
cost CostWhat is the anticipated cost to the patient based on their coverage
therapy-alternatives-opt Therapy Alternatives OptAre there alternative therapies that have better coverage and/or are lower-cost for the patient
therapy-alternatives-req Therapy Alternatives ReqAre there alternative therapies that must be tried first prior to coverage being available for the proposed therapy
clinical-reminder Clinical ReminderReminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)
duplicate-therapy Duplicate TherapyNotice that the proposed intervention has already recently occurred with a different provider when that information isn't already available in the provider system
contraindication ContraindicationNotice that the proposed intervention may be contraindicated based on information the payer has in their record that the provider doesn't have in theirs
guideline GuidelineIndication that there is a guideline available for the proposed therapy (with an option to view)
off-guideline Off GuidelineNotice that the proposed therapy may be contrary to best-practice guidelines, typically with an option to view the relevant guideline