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
Official URL: http://hl7.org/fhir/us/davinci-crd/ValueSet/coveragePaDetail | Version: 2.1.0 | |||
Standards status: Trial-use | Maturity Level: 1 | Computable Name: CRDCoveragePaDetail | ||
Other Identifiers: OID:2.16.840.1.113883.4.642.40.18.48.14 |
Codes defining whether prior auth will be needed for coverage to be provided
References
Generated Narrative: ValueSet coveragePaDetail
http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp
Code | Display | Definition |
no-auth | No Prior Authorization | The ordered service does not require prior authorization |
auth-needed | Prior Authorization Needed | The ordered service will require prior authorization |
satisfied | Authorization Satisfied | While prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed |
performpa | Performer Prior Authorization | Prior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider. |
conditional | Conditional | 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.) |
Generated Narrative: ValueSet
Expansion based on codesystem CRD Temporary Codes v2.1.0 (CodeSystem)
This value set contains 5 concepts
Code | System | Display | Definition |
no-auth | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | No Prior Authorization | The ordered service does not require prior authorization |
auth-needed | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Prior Authorization Needed | The ordered service will require prior authorization |
satisfied | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Authorization Satisfied | While prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed |
performpa | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Performer Prior Authorization | Prior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider. |
conditional | http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp | Conditional | 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.) |
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 |