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. For a full list of available versions, see the Directory of published versions
Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetail | Version: 2.0.1 | |||
Standards status: Trial-use | Maturity Level: 2 | Computable Name: CRDCoverageDetailCodes |
Codes for name-value-pair details on a coverage assertion
References
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp
Code | Display | Definition |
allowed-quantity | Maximum quantity | Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity |
allowed-period | Maximum allowed period | Indicates the maximum period of time that can be covered in a single order. Value should be a Period |
in-network-copay | Copay for in-network | Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity. |
out-network-copay | Copay for out-of-network | Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity. |
auth-out-network-only | Authorization out-of-network only | Authorization is only necessary if out-of-network. Value should be a boolean. |
concurrent-review | Concurrent review | Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean. |
appropriate-use-needed | Appropriate use | Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean. |
Expansion based on codesystem CRD Temporary Codes v2.0.1 (CodeSystem)
This value set contains 7 concepts
Code | System | Display | Definition |
allowed-quantity | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Maximum quantity | Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity |
allowed-period | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Maximum allowed period | Indicates the maximum period of time that can be covered in a single order. Value should be a Period |
in-network-copay | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Copay for in-network | Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity. |
out-network-copay | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Copay for out-of-network | Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity. |
auth-out-network-only | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Authorization out-of-network only | Authorization is only necessary if out-of-network. Value should be a boolean. |
concurrent-review | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Concurrent review | Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean. |
appropriate-use-needed | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Appropriate use | Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean. |
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 |