This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.1.0: STU 2.1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions
Page standards status: Informative |
Generated Narrative: MedicationRequest annotated-example
Coverage Information
url
coverageurl
coveredvalue: conditional
url
pa-neededvalue: satisfied
url
doc-neededvalue: admin
url
doc-purposevalue: withclaim
url
info-neededvalue: performer
url
billingCodevalue: Current Procedural Terminology (CPT®) 77067: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
url
reasonvalue: In-network required unless exigent circumstances
code: Authorization out-of-network only
value: true
qualification: Out-of-network prior auth does not apply if delivery occurs at a service site designated as 'remote'
url
detailurl
questionnairevalue: http://example.org/some-payer/Questionnaire/123|1.3.0
url
datevalue: 2019-02-15
url
coverage-assertion-idvalue: 12345ABC
url
satisfied-pa-idvalue: XXYYZ
url
contactvalue: http://some-payer.org/xyz-sub-org/get-help-here.html
url
expiry-datevalue: 2019-08-01
status: Draft
intent: Original Order
medication: mycophenolate mofetil 250 MG Oral Capsule [Cellcept]
subject: Jane Smith
encounter: ??
authoredOn: 2019-02-15
requester: Dr. Jones
note: Unsolicited prior authorization for Jane Smith to receive 6 tablets Cellcept 250 MG Oral Capsule BID granted. Please note prior authorization # 12345 on claim submission. (By XYZ Insurance @2019-02-15 15:07:18-0500)
dosageInstruction
text: 6 tablets every 12 hours.
timing: Once per 12 hours
DoseAndRates
Dose[x] 6 tablet