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

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: CRD Card Types Code System - JSON Representation

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{
  "resourceType" : "CodeSystem",
  "id" : "cardType",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>This code system http://hl7.org/fhir/us/davinci-crd/CodeSystem/cardType defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">coverage<a name=\"cardType-coverage\"> </a></td><td>Coverage</td><td>Is the therapy covered or not, or are there limitations</td></tr><tr><td style=\"white-space:nowrap\">documentation<a name=\"cardType-documentation\"> </a></td><td>Documentation</td><td>Are there additional documentation requirements</td></tr><tr><td style=\"white-space:nowrap\">prior-auth<a name=\"cardType-prior-auth\"> </a></td><td>Prior Authorization</td><td>Is prior authorization required or not (and possibly provision of unsolicited prior authorizations)</td></tr><tr><td style=\"white-space:nowrap\">dtr-clin<a name=\"cardType-dtr-clin\"> </a></td><td>DTR Clin</td><td>Indication that DTR is relevant for prior authorization, claim or other documentation requirements and that at least some clinical information needs to be captured</td></tr><tr><td style=\"white-space:nowrap\">dtr-admin<a name=\"cardType-dtr-admin\"> </a></td><td>DTR Admin</td><td>Indication 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)</td></tr><tr><td style=\"white-space:nowrap\">claim<a name=\"cardType-claim\"> </a></td><td>Claim</td><td>Information about what steps need to be taken to submit a claim for the service</td></tr><tr><td style=\"white-space:nowrap\">insurance<a name=\"cardType-insurance\"> </a></td><td>Insurance</td><td>Allows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)</td></tr><tr><td style=\"white-space:nowrap\">limits<a name=\"cardType-limits\"> </a></td><td>Limits</td><td>Messages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general</td></tr><tr><td style=\"white-space:nowrap\">network<a name=\"cardType-network\"> </a></td><td>Network</td><td>Providing information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)</td></tr><tr><td style=\"white-space:nowrap\">appropriate-use<a name=\"cardType-appropriate-use\"> </a></td><td>Appropriate Use</td><td>Guidance on whether appropriate-use documentation is needed</td></tr><tr><td style=\"white-space:nowrap\">cost<a name=\"cardType-cost\"> </a></td><td>Cost</td><td>What is the anticipated cost to the patient based on their coverage</td></tr><tr><td style=\"white-space:nowrap\">therapy-alternatives-opt<a name=\"cardType-therapy-alternatives-opt\"> </a></td><td>Therapy Alternatives Opt</td><td>Are there alternative therapies that have better coverage and/or are lower-cost for the patient</td></tr><tr><td style=\"white-space:nowrap\">therapy-alternatives-req<a name=\"cardType-therapy-alternatives-req\"> </a></td><td>Therapy Alternatives Req</td><td>Are there alternative therapies that must be tried first prior to coverage being available for the proposed therapy</td></tr><tr><td style=\"white-space:nowrap\">clinical-reminder<a name=\"cardType-clinical-reminder\"> </a></td><td>Clinical Reminder</td><td>Reminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)</td></tr><tr><td style=\"white-space:nowrap\">duplicate-therapy<a name=\"cardType-duplicate-therapy\"> </a></td><td>Duplicate Therapy</td><td>Notice that the proposed intervention has already recently occurred with a different provider when that information isn't already available in the provider system</td></tr><tr><td style=\"white-space:nowrap\">contraindication<a name=\"cardType-contraindication\"> </a></td><td>Contraindication</td><td>Notice that the proposed intervention may be contraindicated based on information the payer has in their record that the provider doesn't have in theirs</td></tr><tr><td style=\"white-space:nowrap\">guideline<a name=\"cardType-guideline\"> </a></td><td>Guideline</td><td>Indication that there is a guideline available for the proposed therapy (with an option to view)</td></tr><tr><td style=\"white-space:nowrap\">off-guideline<a name=\"cardType-off-guideline\"> </a></td><td>Off Guideline</td><td>Notice that the proposed therapy may be contrary to best-practice guidelines, typically with an option to view the relevant guideline</td></tr></table></div>"
  },
  "url" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/cardType",
  "version" : "1.1.0-ballot",
  "name" : "CardType",
  "title" : "CRD Card Types Code System",
  "status" : "draft",
  "date" : "2022-02-17T08:05:13+00:00",
  "publisher" : "HL7 International - Financial Management Work Group",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fm"
        }
      ]
    }
  ],
  "description" : "List of card types",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "caseSensitive" : true,
  "content" : "complete",
  "concept" : [
    {
      "code" : "coverage",
      "display" : "Coverage",
      "definition" : "Is the therapy covered or not, or are there limitations"
    },
    {
      "code" : "documentation",
      "display" : "Documentation",
      "definition" : "Are there additional documentation requirements"
    },
    {
      "code" : "prior-auth",
      "display" : "Prior Authorization",
      "definition" : "Is prior authorization required or not (and possibly provision of unsolicited prior authorizations)"
    },
    {
      "code" : "dtr-clin",
      "display" : "DTR Clin",
      "definition" : "Indication that DTR is relevant for prior authorization, claim or other documentation requirements and that at least some clinical information needs to be captured"
    },
    {
      "code" : "dtr-admin",
      "display" : "DTR Admin",
      "definition" : "Indication 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)"
    },
    {
      "code" : "claim",
      "display" : "Claim",
      "definition" : "Information about what steps need to be taken to submit a claim for the service"
    },
    {
      "code" : "insurance",
      "display" : "Insurance",
      "definition" : "Allows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)"
    },
    {
      "code" : "limits",
      "display" : "Limits",
      "definition" : "Messages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general"
    },
    {
      "code" : "network",
      "display" : "Network",
      "definition" : "Providing information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)"
    },
    {
      "code" : "appropriate-use",
      "display" : "Appropriate Use",
      "definition" : "Guidance on whether appropriate-use documentation is needed"
    },
    {
      "code" : "cost",
      "display" : "Cost",
      "definition" : "What is the anticipated cost to the patient based on their coverage"
    },
    {
      "code" : "therapy-alternatives-opt",
      "display" : "Therapy Alternatives Opt",
      "definition" : "Are there alternative therapies that have better coverage and/or are lower-cost for the patient"
    },
    {
      "code" : "therapy-alternatives-req",
      "display" : "Therapy Alternatives Req",
      "definition" : "Are there alternative therapies that must be tried first prior to coverage being available for the proposed therapy"
    },
    {
      "code" : "clinical-reminder",
      "display" : "Clinical Reminder",
      "definition" : "Reminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)"
    },
    {
      "code" : "duplicate-therapy",
      "display" : "Duplicate Therapy",
      "definition" : "Notice that the proposed intervention has already recently occurred with a different provider when that information isn't already available in the provider system"
    },
    {
      "code" : "contraindication",
      "display" : "Contraindication",
      "definition" : "Notice that the proposed intervention may be contraindicated based on information the payer has in their record that the provider doesn't have in theirs"
    },
    {
      "code" : "guideline",
      "display" : "Guideline",
      "definition" : "Indication that there is a guideline available for the proposed therapy (with an option to view)"
    },
    {
      "code" : "off-guideline",
      "display" : "Off Guideline",
      "definition" : "Notice that the proposed therapy may be contrary to best-practice guidelines, typically with an option to view the relevant guideline"
    }
  ]
}