Da Vinci - Coverage Requirements Discovery
2.0.1 - STU 2 United States of America flag

This page is part of the Da Vinci Coverage Requirements Discovery (CRD) FHIR IG (v2.0.1: STU 2.0) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Extension: Coverage Information

Official URL: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information Version: 2.0.1
Standards status: Trial-use Maturity Level: 1 Computable Name: CoverageInformation

Captures assertions from a payer about whether the service is covered and/or requires prior authorization.

Context of Use

This extension may be used on the following element(s):

  • Element ID QuestionnaireResponse
  • Element ID Encounter
  • Element ID NutritionOrder
  • Element ID CommunicationRequest
  • Element ID DeviceRequest
  • Element ID ServiceRequest
  • Element ID MedicationRequest

Usage info

Usage:

Formal Views of Extension Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

This structure is derived from Extension

Summary

Complex Extension: Captures assertions from a payer about whether the service is covered and/or requires prior authorization.

  • coverage: Reference: Reference to Coverage that assertion applies to.
  • covered: code: Indicates whether the ordered/requested service is covered under patient's plan
  • pa-needed: code: Indicates whether prior auth will be needed for coverage to be provided
  • doc-needed: code: Indicates whether additional documentation needs to be captured (purpose in next element)
  • doc-purpose: code: An Extension
  • info-needed: code: Indicates whether information about the perfomer, location, and/or performance date is needed to determine coverage information
  • billingCode: Coding: Billing code(s) that must be used in the eventual claim for the coverage assertion to hold
  • reason: CodeableConcept: Indicates the 'reason' for the coverage assertion
  • code: CodeableConcept: The type of detail or qualification expressed.
  • value: boolean, string, Period, Quantity: The detail or qualification that applies to this coverage assertion.
  • qualification: string: Additional text that qualifies/expands on the computable detail. E.g. 'Provided coverage is renewed' or 'Does not account for deductible'
  • dependency: Reference: If present, indicates that the determination represented here is dependent on the content, determination, and possibly execution of the referenced order(s)
  • questionnaire: canonical: A form to be filled out to gather more information. Only for use if the response indicates a need to use DTR
  • response: Reference: A reference to a partially completed Questionnaire Response that is intended to be used as a basis for subsequent form filling in DTR.
  • date: date: Date on which assertion was made.
  • coverage-assertion-id: string: Trace identifier to allow tracking the guidance in source system. This identifier can also be used used to re-establish cached context information when subsequently launching DTR.
  • satisfied-pa-id: string: An Extension
  • contact: ContactPoint: Phone number, fax number, email address, website, or other ContactPoint that can be used to ask questions/escalate issues related to a coverage assertion.

Maturity: 1

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension C0..*ExtensionCoverageInfo
crd-ci-q1: Questionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc'
crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' should not exist.
crd-ci-q3: If 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'.
crd-ci-q4: If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'.
crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'.
... extension 4..*ExtensionExtension
... extension:coverage 1..1ExtensionReference to Coverage
.... extension 0..0
.... url 1..1uri"coverage"
.... value[x] 1..1Reference(CRD Coverage)Value of extension
... extension:covered S1..1Extensioncovered | not-covered | conditional
.... extension 0..0
.... url 1..1uri"covered"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Covered Value Set (required)
.... extension 0..0
.... url 1..1uri"pa-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Prior Authorization Value Set (required)
... extension:doc-needed S0..1Extensionclinical | admin | both | conditional
.... extension 0..0
.... url 1..1uri"doc-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Additional Documentation Value Set (required)
... extension:doc-purpose S0..*ExtensionDocumentation purpose
.... extension 0..0
.... url 1..1uri"doc-purpose"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Documentation Reason Value Set (required)
... extension:info-needed S0..*Extensionperformer | location | timeframe
.... extension 0..0
.... url 1..1uri"info-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Information Needed Value Set (required)
... extension:billingCode 0..*ExtensionBilling code
.... extension 0..0
.... url 1..1uri"billingCode"
.... value[x] 1..1CodingValue of extension
Binding: USCLSCodes (example)
... extension:reason 0..*ExtensionReason for assertion
.... extension 0..0
.... url 1..1uri"reason"
.... value[x] 1..1CodeableConceptValue of extension
Binding: CRD Coverage Assertion Reasons (extensible)
... extension:detail 0..*Extensiondetail for assertion
.... extension 2..*ExtensionExtension
.... extension:code 1..1ExtensionName of name-value pair
..... extension 0..0
..... url 1..1uri"code"
..... value[x] 0..1CodeableConceptValue of extension
Binding: CRD Coverage Detail Codes Value Set (extensible)
.... extension:value 1..1ExtensionValue of name-value pair
..... extension 0..0
..... url 1..1uri"value"
..... value[x] 0..1Value of extension
...... valueBooleanboolean
...... valueStringstring
...... valuePeriodPeriod
...... valueQuantityQuantity(SimpleQuantity)
.... extension:qualification 0..1ExtensionAdditional info about detail
..... extension 0..0
..... url 1..1uri"qualification"
..... value[x] 0..1stringValue of extension
.... url 1..1uri"detail"
.... value[x] 0..0
... extension:dependency 0..*ExtensionResources that impact this assertion
.... extension 0..0
.... url 1..1uri"dependency"
.... value[x] 0..1Reference(CRD Appointment | CRD Communication Request | CRD Device Request | CRD Medication Request | CRD Nutrition Order | CRD Service Request)Value of extension
... extension:questionnaire C0..*ExtensionQuestionnaire
.... extension 0..0
.... url 1..1uri"questionnaire"
.... value[x] 0..1canonical(Questionnaire)Value of extension
... extension:response C0..*ExtensionQuestionnaire Response
.... extension 0..0
.... url 1..1uri"response"
.... value[x] 0..1Reference(QuestionnaireResponse)Value of extension
... extension:date 1..1ExtensionAssertion date
.... extension 0..0
.... url 1..1uri"date"
.... value[x] 1..1dateValue of extension
... extension:coverage-assertion-id 1..1Extensioncoverage-assertion-id
.... extension 0..0
.... url 1..1uri"coverage-assertion-id"
.... value[x] 0..1stringValue of extension
... extension:satisfied-pa-id 0..1Extensionsatisfied-pa-id
.... extension 0..0
.... url 1..1uri"satisfied-pa-id"
.... value[x] 0..1stringValue of extension
... extension:contact 0..*ExtensionContact
.... extension 0..0
.... url 1..1uri"contact"
.... value[x] 0..1ContactPointValue of extension
... url 1..1uri"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"
... value[x] 0..0

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension C0..*ExtensionCoverageInfo
crd-ci-q1: Questionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc'
crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' should not exist.
crd-ci-q3: If 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'.
crd-ci-q4: If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'.
crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'.
... id 0..1stringUnique id for inter-element referencing
... Slices for extension 4..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension:coverage 1..1ExtensionReference to Coverage
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"coverage"
.... value[x] 1..1Reference(CRD Coverage)Value of extension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"covered"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Covered Value Set (required)
... extension:pa-needed S0..1Extensionno-auth | auth-needed | satisfied | performpa | conditional
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"pa-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Prior Authorization Value Set (required)
... extension:doc-needed S0..1Extensionclinical | admin | both | conditional
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"doc-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Additional Documentation Value Set (required)
... extension:doc-purpose S0..*ExtensionDocumentation purpose
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"doc-purpose"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Documentation Reason Value Set (required)
... extension:info-needed S0..*Extensionperformer | location | timeframe
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"info-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Information Needed Value Set (required)
... extension:billingCode 0..*ExtensionBilling code
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"billingCode"
.... value[x] 1..1CodingValue of extension
Binding: USCLSCodes (example)
... extension:reason 0..*ExtensionReason for assertion
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"reason"
.... value[x] 1..1CodeableConceptValue of extension
Binding: CRD Coverage Assertion Reasons (extensible)
... extension:detail 0..*Extensiondetail for assertion
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 2..*ExtensionExtension
Slice: Unordered, Open by value:url
.... extension:code 1..1ExtensionName of name-value pair
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..0
..... url 1..1uri"code"
..... value[x] 0..1CodeableConceptValue of extension
Binding: CRD Coverage Detail Codes Value Set (extensible)
.... extension:value 1..1ExtensionValue of name-value pair
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..0
..... url 1..1uri"value"
..... value[x] 0..1Value of extension
...... valueBooleanboolean
...... valueStringstring
...... valuePeriodPeriod
...... valueQuantityQuantity(SimpleQuantity)
.... extension:qualification 0..1ExtensionAdditional info about detail
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..0
..... url 1..1uri"qualification"
..... value[x] 0..1stringValue of extension
.... url 1..1uri"detail"
... extension:dependency 0..*ExtensionResources that impact this assertion
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"dependency"
.... value[x] 0..1Reference(CRD Appointment | CRD Communication Request | CRD Device Request | CRD Medication Request | CRD Nutrition Order | CRD Service Request)Value of extension
... extension:questionnaire C0..*ExtensionQuestionnaire
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"questionnaire"
.... value[x] 0..1canonical(Questionnaire)Value of extension
... extension:response C0..*ExtensionQuestionnaire Response
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"response"
.... value[x] 0..1Reference(QuestionnaireResponse)Value of extension
... extension:date 1..1ExtensionAssertion date
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"date"
.... value[x] 1..1dateValue of extension
... extension:coverage-assertion-id 1..1Extensioncoverage-assertion-id
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"coverage-assertion-id"
.... value[x] 0..1stringValue of extension
... extension:satisfied-pa-id 0..1Extensionsatisfied-pa-id
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"satisfied-pa-id"
.... value[x] 0..1stringValue of extension
... extension:contact 0..*ExtensionContact
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"contact"
.... value[x] 0..1ContactPointValue of extension
... url 1..1uri"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"

doco Documentation for this format

This structure is derived from Extension

Summary

Complex Extension: Captures assertions from a payer about whether the service is covered and/or requires prior authorization.

  • coverage: Reference: Reference to Coverage that assertion applies to.
  • covered: code: Indicates whether the ordered/requested service is covered under patient's plan
  • pa-needed: code: Indicates whether prior auth will be needed for coverage to be provided
  • doc-needed: code: Indicates whether additional documentation needs to be captured (purpose in next element)
  • doc-purpose: code: An Extension
  • info-needed: code: Indicates whether information about the perfomer, location, and/or performance date is needed to determine coverage information
  • billingCode: Coding: Billing code(s) that must be used in the eventual claim for the coverage assertion to hold
  • reason: CodeableConcept: Indicates the 'reason' for the coverage assertion
  • code: CodeableConcept: The type of detail or qualification expressed.
  • value: boolean, string, Period, Quantity: The detail or qualification that applies to this coverage assertion.
  • qualification: string: Additional text that qualifies/expands on the computable detail. E.g. 'Provided coverage is renewed' or 'Does not account for deductible'
  • dependency: Reference: If present, indicates that the determination represented here is dependent on the content, determination, and possibly execution of the referenced order(s)
  • questionnaire: canonical: A form to be filled out to gather more information. Only for use if the response indicates a need to use DTR
  • response: Reference: A reference to a partially completed Questionnaire Response that is intended to be used as a basis for subsequent form filling in DTR.
  • date: date: Date on which assertion was made.
  • coverage-assertion-id: string: Trace identifier to allow tracking the guidance in source system. This identifier can also be used used to re-establish cached context information when subsequently launching DTR.
  • satisfied-pa-id: string: An Extension
  • contact: ContactPoint: Phone number, fax number, email address, website, or other ContactPoint that can be used to ask questions/escalate issues related to a coverage assertion.

Maturity: 1

Differential View

This structure is derived from Extension

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension C0..*ExtensionCoverageInfo
crd-ci-q1: Questionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc'
crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' should not exist.
crd-ci-q3: If 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'.
crd-ci-q4: If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'.
crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'.
... extension 4..*ExtensionExtension
... extension:coverage 1..1ExtensionReference to Coverage
.... extension 0..0
.... url 1..1uri"coverage"
.... value[x] 1..1Reference(CRD Coverage)Value of extension
... extension:covered S1..1Extensioncovered | not-covered | conditional
.... extension 0..0
.... url 1..1uri"covered"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Covered Value Set (required)
.... extension 0..0
.... url 1..1uri"pa-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Prior Authorization Value Set (required)
... extension:doc-needed S0..1Extensionclinical | admin | both | conditional
.... extension 0..0
.... url 1..1uri"doc-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Additional Documentation Value Set (required)
... extension:doc-purpose S0..*ExtensionDocumentation purpose
.... extension 0..0
.... url 1..1uri"doc-purpose"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Documentation Reason Value Set (required)
... extension:info-needed S0..*Extensionperformer | location | timeframe
.... extension 0..0
.... url 1..1uri"info-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Information Needed Value Set (required)
... extension:billingCode 0..*ExtensionBilling code
.... extension 0..0
.... url 1..1uri"billingCode"
.... value[x] 1..1CodingValue of extension
Binding: USCLSCodes (example)
... extension:reason 0..*ExtensionReason for assertion
.... extension 0..0
.... url 1..1uri"reason"
.... value[x] 1..1CodeableConceptValue of extension
Binding: CRD Coverage Assertion Reasons (extensible)
... extension:detail 0..*Extensiondetail for assertion
.... extension 2..*ExtensionExtension
.... extension:code 1..1ExtensionName of name-value pair
..... extension 0..0
..... url 1..1uri"code"
..... value[x] 0..1CodeableConceptValue of extension
Binding: CRD Coverage Detail Codes Value Set (extensible)
.... extension:value 1..1ExtensionValue of name-value pair
..... extension 0..0
..... url 1..1uri"value"
..... value[x] 0..1Value of extension
...... valueBooleanboolean
...... valueStringstring
...... valuePeriodPeriod
...... valueQuantityQuantity(SimpleQuantity)
.... extension:qualification 0..1ExtensionAdditional info about detail
..... extension 0..0
..... url 1..1uri"qualification"
..... value[x] 0..1stringValue of extension
.... url 1..1uri"detail"
.... value[x] 0..0
... extension:dependency 0..*ExtensionResources that impact this assertion
.... extension 0..0
.... url 1..1uri"dependency"
.... value[x] 0..1Reference(CRD Appointment | CRD Communication Request | CRD Device Request | CRD Medication Request | CRD Nutrition Order | CRD Service Request)Value of extension
... extension:questionnaire C0..*ExtensionQuestionnaire
.... extension 0..0
.... url 1..1uri"questionnaire"
.... value[x] 0..1canonical(Questionnaire)Value of extension
... extension:response C0..*ExtensionQuestionnaire Response
.... extension 0..0
.... url 1..1uri"response"
.... value[x] 0..1Reference(QuestionnaireResponse)Value of extension
... extension:date 1..1ExtensionAssertion date
.... extension 0..0
.... url 1..1uri"date"
.... value[x] 1..1dateValue of extension
... extension:coverage-assertion-id 1..1Extensioncoverage-assertion-id
.... extension 0..0
.... url 1..1uri"coverage-assertion-id"
.... value[x] 0..1stringValue of extension
... extension:satisfied-pa-id 0..1Extensionsatisfied-pa-id
.... extension 0..0
.... url 1..1uri"satisfied-pa-id"
.... value[x] 0..1stringValue of extension
... extension:contact 0..*ExtensionContact
.... extension 0..0
.... url 1..1uri"contact"
.... value[x] 0..1ContactPointValue of extension
... url 1..1uri"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"
... value[x] 0..0

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Extension C0..*ExtensionCoverageInfo
crd-ci-q1: Questionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc'
crd-ci-q2: If covered is set to 'not-covered', then 'pa-needed' should not exist.
crd-ci-q3: If 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'.
crd-ci-q4: If 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'.
crd-ci-q5: 'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'.
... id 0..1stringUnique id for inter-element referencing
... Slices for extension 4..*ExtensionExtension
Slice: Unordered, Open by value:url
... extension:coverage 1..1ExtensionReference to Coverage
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"coverage"
.... value[x] 1..1Reference(CRD Coverage)Value of extension
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"covered"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Covered Value Set (required)
... extension:pa-needed S0..1Extensionno-auth | auth-needed | satisfied | performpa | conditional
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"pa-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Prior Authorization Value Set (required)
... extension:doc-needed S0..1Extensionclinical | admin | both | conditional
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"doc-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Additional Documentation Value Set (required)
... extension:doc-purpose S0..*ExtensionDocumentation purpose
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"doc-purpose"
.... value[x] 1..1codeValue of extension
Binding: CRD Coverage Information Documentation Reason Value Set (required)
... extension:info-needed S0..*Extensionperformer | location | timeframe
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"info-needed"
.... value[x] 1..1codeValue of extension
Binding: CRD Information Needed Value Set (required)
... extension:billingCode 0..*ExtensionBilling code
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"billingCode"
.... value[x] 1..1CodingValue of extension
Binding: USCLSCodes (example)
... extension:reason 0..*ExtensionReason for assertion
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"reason"
.... value[x] 1..1CodeableConceptValue of extension
Binding: CRD Coverage Assertion Reasons (extensible)
... extension:detail 0..*Extensiondetail for assertion
.... id 0..1stringUnique id for inter-element referencing
.... Slices for extension 2..*ExtensionExtension
Slice: Unordered, Open by value:url
.... extension:code 1..1ExtensionName of name-value pair
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..0
..... url 1..1uri"code"
..... value[x] 0..1CodeableConceptValue of extension
Binding: CRD Coverage Detail Codes Value Set (extensible)
.... extension:value 1..1ExtensionValue of name-value pair
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..0
..... url 1..1uri"value"
..... value[x] 0..1Value of extension
...... valueBooleanboolean
...... valueStringstring
...... valuePeriodPeriod
...... valueQuantityQuantity(SimpleQuantity)
.... extension:qualification 0..1ExtensionAdditional info about detail
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..0
..... url 1..1uri"qualification"
..... value[x] 0..1stringValue of extension
.... url 1..1uri"detail"
... extension:dependency 0..*ExtensionResources that impact this assertion
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"dependency"
.... value[x] 0..1Reference(CRD Appointment | CRD Communication Request | CRD Device Request | CRD Medication Request | CRD Nutrition Order | CRD Service Request)Value of extension
... extension:questionnaire C0..*ExtensionQuestionnaire
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"questionnaire"
.... value[x] 0..1canonical(Questionnaire)Value of extension
... extension:response C0..*ExtensionQuestionnaire Response
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"response"
.... value[x] 0..1Reference(QuestionnaireResponse)Value of extension
... extension:date 1..1ExtensionAssertion date
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"date"
.... value[x] 1..1dateValue of extension
... extension:coverage-assertion-id 1..1Extensioncoverage-assertion-id
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"coverage-assertion-id"
.... value[x] 0..1stringValue of extension
... extension:satisfied-pa-id 0..1Extensionsatisfied-pa-id
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"satisfied-pa-id"
.... value[x] 0..1stringValue of extension
... extension:contact 0..*ExtensionContact
.... id 0..1stringUnique id for inter-element referencing
.... extension 0..0
.... url 1..1uri"contact"
.... value[x] 0..1ContactPointValue of extension
... url 1..1uri"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information"

doco Documentation for this format

 

Other representations of profile: CSV, Excel, Schematron

Terminology Bindings

PathConformanceValueSet
Extension.extension:covered.value[x]requiredCRDCoveredInfo
Extension.extension:pa-needed.value[x]requiredCRDCoveragePaDetail
Extension.extension:doc-needed.value[x]requiredCRDAdditionalDoc
Extension.extension:doc-purpose.value[x]requiredCRDDocReason
Extension.extension:info-needed.value[x]requiredCRDInformationNeeded
Extension.extension:billingCode.value[x]exampleUSCLSCodes
Extension.extension:reason.value[x]extensibleCRDCoverageAssertionReasons
Extension.extension:detail.extension:code.value[x]extensibleCRDCoverageDetailCodes

Constraints

IdGradePath(s)DetailsRequirements
crd-ci-q1errorExtensionQuestionnaire and QuestionnaireResponse are only allowed when doc-needed exists and not equal to 'no-doc'
: extension.where(url='questionnaire' or url='response').exists() implies (extension.where(url = 'doc-needed').exists() and extension.where(url = 'doc-needed').all(value != 'no-doc'))
crd-ci-q2errorExtensionIf covered is set to 'not-covered', then 'pa-needed' should not exist.
: extension.where(url = 'covered' and value != 'not-covered') implies extension.where(url = 'pa-needed').exists()
crd-ci-q3errorExtensionIf 'info-needed' exists, then at least one of 'covered', 'pa-needed', or 'doc-needed' must be 'conditional'.
: extension.where(url = 'info-needed').exists() implies extension.where((url = 'covered' or url = 'pa-needed' or url = 'doc-needed') and value = 'conditional').count() >= 1
crd-ci-q4errorExtensionIf 'pa-needed' is 'satisfied', then 'Doc-purpose' can't be 'PA'.
: extension.where(url = 'pa-needed' and value = 'satisfied') and extension.where(url = 'doc-purpose').exists() implies extension.where(url = 'doc-purpose').all(value != 'PA')
crd-ci-q5errorExtension'satisfied-pa-id' must exist if and only if 'pa-needed' is set to 'satisfied'.
: extension.where(url = 'pa-needed' and value = 'satisfied').exists() = extension.where(url = 'satisfied-pa-id').exists()
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
ext-1error**ALL** extensionsMust have either extensions or value[x], not both
: extension.exists() != value.exists()