Medical Management Type

{
  "description" : "Types of medical management requirements or processes used by health insurers (payers) that may impact whether a service or item is covered or reimbursement rates.",
  "date" : "2026-03-08T18:17:17-06:00",
  "meta" : {
    "lastUpdated" : "2025-05-26T00:00:00+00:00",
    "profile" : [ "http://hl7.org/fhir/StructureDefinition/shareablecodesystem" ]
  },
  "publisher" : "Health Level Seven International",
  "content" : "complete",
  "property" : null,
  "name" : "MedicalManagementType",
  "copyright" : "This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license",
  "experimental" : false,
  "resourceType" : "CodeSystem",
  "title" : "Medical Management Type",
  "extension" : [ {
    "valueCode" : "fm",
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"
  }, {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 1
  }, {
    "extension" : [ {
      "valueString" : "concept",
      "url" : "path"
    }, {
      "url" : "count",
      "valueInteger" : 3
    } ],
    "url" : "http://health-samurai.io/extensions/excised-data"
  }, {
    "url" : "http://health-samurai.io/extensions/source",
    "valueCode" : "db"
  } ],
  "status" : "active",
  "language" : "en",
  "id" : "medical-management-type",
  "valueSet" : "http://terminology.hl7.org/ValueSet/medical-management-type",
  "url" : "http://terminology.hl7.org/CodeSystem/medical-management-type",
  "identifier" : [ {
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.5.175"
  } ],
  "caseSensitive" : true,
  "version" : "1.0.0",
  "contact" : [ {
    "telecom" : [ {
      "system" : "url",
      "value" : "http://hl7.org"
    }, {
      "system" : "email",
      "value" : "hq@HL7.org"
    } ]
  } ],
  "text" : {
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem medical-management-type</b></p><a name=\"medical-management-type\"> </a><a name=\"hcmedical-management-type\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Last updated: 2025-05-26 00:00:00+0000; Language: en</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/R5/shareablecodesystem.html\">Shareable CodeSystem</a></p></div><p>This case-sensitive code system <code>http://terminology.hl7.org/CodeSystem/medical-management-type</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">concurrent-review<a name=\"medical-management-type-concurrent-review\"> </a></td><td>Concurrent Review</td><td>Review of medical necessity while the patient is actively receiving treatment.</td></tr><tr><td style=\"white-space:nowrap\">prior-auth<a name=\"medical-management-type-prior-auth\"> </a></td><td>Prior Authorization</td><td>Review of medical necessity prior to receiving treatment.</td></tr><tr><td style=\"white-space:nowrap\">step-therapy<a name=\"medical-management-type-step-therapy\"> </a></td><td>Step Therapy (Fail First)</td><td>Requirement that lower cost or preferred treatments be tried, or perhaps contra-indicated, before alternatives are utilized. This policy is sometimes referred to as 'fail first'.</td></tr></table></div>",
    "status" : "generated"
  }
}