Da Vinci - Coverage Requirements Discovery
2.2.0-ballot - STU 2.2 Ballot United States of America flag

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.2.0-ballot: STU 2.2 Ballot) based on FHIR (HL7® FHIR® Standard) R4. This version is a pre-release. The current official version is 2.1.0. For a full list of available versions, see the Directory of published versions

ValueSet: CRD Coverage Assertion Reasons Value Set

Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons Version: 2.2.0-ballot
Standards status: Trial-use Maturity Level: 1 Computable Name: CRDCoverageAssertionReasons
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.10

Reasons for a coverage assertion in the coverage-information extension

References

As mentioned in the ballot introduction, this value set uses codes slated to be moved from the temporary code system to a more permanent URL.

Logical Definition (CLD)

  • Include these codes as defined in http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp
    CodeDisplayDefinition
    gold-cardGold cardOrdering Practitioner has been granted 'gold card' status with this payer/coverage type.
    no-member-foundMember not foundThe CRD service was unable to find a matching member, so no coverage information can be provided
    no-active-coverageCoverage not activeThe referenced insurance coverage for the member is not active, so no coverage information can be provided
    auth-out-networkAuthorization needed out-of-networkAuthorization is necessary if out-of-network.

 

Expansion

Expansion performed internally based on codesystem CRD Temporary Codes v2.2.0-ballot (CodeSystem)

This value set contains 4 concepts

CodeSystemDisplay (en-US)Definition
  gold-cardhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempGold cardOrdering Practitioner has been granted 'gold card' status with this payer/coverage type.
  no-member-foundhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempMember not foundThe CRD service was unable to find a matching member, so no coverage information can be provided
  no-active-coveragehttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempCoverage not activeThe referenced insurance coverage for the member is not active, so no coverage information can be provided
  auth-out-networkhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/tempAuthorization needed out-of-networkAuthorization is necessary if out-of-network.

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code