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: Trial-use | Maturity Level: 1 |
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<id value="coveragePaDetail"/>
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<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>
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<valueInteger value="1"/>
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<extension
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<valueCode value="fm"/>
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<valueCode value="trial-use">
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<valueCanonical
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<url value="http://hl7.org/fhir/us/davinci-crd/ValueSet/coveragePaDetail"/>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:oid:2.16.840.1.113883.4.642.40.18.48.14"/>
</identifier>
<version value="2.1.0"/>
<name value="CRDCoveragePaDetail"/>
<title value="CRD Coverage Information Prior Authorization Value Set"/>
<status value="active"/>
<experimental value="false"/>
<date value="2024-12-11T19:24:00+00:00"/>
<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"/>
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<system value="http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp"/>
<concept>
<code value="no-auth"/>
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<concept>
<code value="auth-needed"/>
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<concept>
<code value="satisfied"/>
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<concept>
<code value="performpa"/>
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<concept>
<code value="conditional"/>
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