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

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: CRD Coverage Assertion Reasons Value Set - JSON Representation

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{
  "resourceType" : "ValueSet",
  "id" : "coverageAssertionReasons",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet coverageAssertionReasons</b></p><a name=\"coverageAssertionReasons\"> </a><a name=\"hccoverageAssertionReasons\"> </a><ul><li>Include these codes as defined in <a href=\"CodeSystem-temp.html\"><code>http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp</code></a><table class=\"none\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-gold-card\">gold-card</a></td><td style=\"color: #cccccc\">Gold card</td><td>Ordering Practitioner has been granted 'gold card' status with this payer/coverage type.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-no-member-found\">no-member-found</a></td><td style=\"color: #cccccc\">Member not found</td><td>The CRD service was unable to find a matching member, so no coverage information can be provided</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-no-active-coverage\">no-active-coverage</a></td><td style=\"color: #cccccc\">Coverage not active</td><td>The referenced insurance coverage for the member is not active, so no coverage information can be provided</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-auth-out-network\">auth-out-network</a></td><td style=\"color: #cccccc\">Authorization needed out-of-network</td><td>Authorization is necessary if out-of-network.</td></tr></table></li></ul></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger" : 1
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "fm"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageAssertionReasons",
  "identifier" : [
    {
      "system" : "urn:ietf:rfc:3986",
      "value" : "urn:oid:2.16.840.1.113883.4.642.40.18.48.10"
    }
  ],
  "version" : "2.2.0-ballot",
  "name" : "CRDCoverageAssertionReasons",
  "title" : "CRD Coverage Assertion Reasons Value Set",
  "status" : "active",
  "experimental" : false,
  "date" : "2025-08-06T17:27:13+00:00",
  "publisher" : "HL7 International / Financial Management",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/fm"
        }
      ]
    }
  ],
  "description" : "Reasons for a coverage assertion in the coverage-information extension",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "compose" : {
    "include" : [
      {
        "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
        "concept" : [
          {
            "code" : "gold-card"
          },
          {
            "code" : "no-member-found"
          },
          {
            "code" : "no-active-coverage"
          },
          {
            "code" : "auth-out-network"
          }
        ]
      }
    ]
  }
}