This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.1.0-preview: STU 2.1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.1. For a full list of available versions, see the Directory of published versions

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: CRD Coverage Information Prior Authorization Value Set - XML Representation

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<ValueSet xmlns="http://hl7.org/fhir">
  <id value="coveragePaDetail"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ValueSet coveragePaDetail</b></p><a name="coveragePaDetail"> </a><a name="hccoveragePaDetail"> </a><a name="coveragePaDetail-en-US"> </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-no-auth">no-auth</a></td><td style="color: #cccccc">No Prior Authorization</td><td>The ordered service does not require prior authorization</td></tr><tr><td><a href="CodeSystem-temp.html#temp-auth-needed">auth-needed</a></td><td style="color: #cccccc">Prior Authorization Needed</td><td>The ordered service will require prior authorization</td></tr><tr><td><a href="CodeSystem-temp.html#temp-satisfied">satisfied</a></td><td style="color: #cccccc">Authorization Satisfied</td><td>While prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed</td></tr><tr><td><a href="CodeSystem-temp.html#temp-performpa">performpa</a></td><td style="color: #cccccc">Performer Prior Authorization</td><td>Prior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider.</td></tr><tr><td><a href="CodeSystem-temp.html#temp-conditional">conditional</a></td><td style="color: #cccccc">Conditional</td><td>There is the potential for information requirements from a participant type not listed.  However, a decision on whether there in fact are additional information requirements cannot be made without more information (more detailed code, service rendering information, etc.)</td></tr></table></li></ul></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="1"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"/>
      </extension>
    </valueCode>
  </extension>
  <url value="http://hl7.org/fhir/us/davinci-crd/ValueSet/coveragePaDetail"/>
  <version value="2.1.0-preview"/>
  <name value="CRDCoveragePaDetail"/>
  <title value="CRD Coverage Information Prior Authorization Value Set"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2024-09-26T14:59:51-04:00"/>
  <publisher value="HL7 International / Financial Management"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/fm"/>
    </telecom>
  </contact>
  <description
               value="Codes defining whether prior auth will be needed for coverage to be provided"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <compose>
    <include>
      <system value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
      <concept>
        <code value="no-auth"/>
      </concept>
      <concept>
        <code value="auth-needed"/>
      </concept>
      <concept>
        <code value="satisfied"/>
      </concept>
      <concept>
        <code value="performpa"/>
      </concept>
      <concept>
        <code value="conditional"/>
      </concept>
    </include>
  </compose>
</ValueSet>