CRD Coverage Detail Codes Value Set

{
  "description" : "Codes for name-value-pair details on a coverage assertion",
  "compose" : {
    "exclude" : [ ],
    "include" : [ {
      "system" : "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
      "extension" : [ {
        "extension" : [ {
          "valueString" : "concept",
          "url" : "path"
        }, {
          "url" : "count",
          "valueInteger" : 11
        } ],
        "url" : "http://health-samurai.io/extensions/excised-data"
      } ]
    } ]
  },
  "date" : "2024-12-11T18:49:53+00:00",
  "publisher" : "HL7 International / Financial Management",
  "jurisdiction" : [ {
    "coding" : [ {
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    } ]
  } ],
  "name" : "CRDCoverageDetailCodes",
  "experimental" : false,
  "resourceType" : "ValueSet",
  "title" : "CRD Coverage Detail Codes Value Set",
  "extension" : [ {
    "valueCode" : "fm",
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"
  }, {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 3,
    "_valueInteger" : {
      "extension" : [ {
        "valueCanonical" : "http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd",
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"
      } ]
    }
  }, {
    "valueCode" : "trial-use",
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "_valueCode" : {
      "extension" : [ {
        "valueCanonical" : "http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd",
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"
      } ]
    }
  }, {
    "url" : "http://health-samurai.io/extensions/source",
    "valueCode" : "db"
  } ],
  "status" : "active",
  "id" : "coverageDetail",
  "url" : "http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetail",
  "identifier" : [ {
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.18.48.12"
  } ],
  "version" : "2.1.0",
  "contact" : [ {
    "telecom" : [ {
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/fm"
    } ]
  } ],
  "text" : {
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ValueSet coverageDetail</b></p><a name=\"coverageDetail\"> </a><a name=\"hccoverageDetail\"> </a><a name=\"coverageDetail-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-allowed-quantity\">allowed-quantity</a></td><td style=\"color: #cccccc\">Maximum quantity</td><td>Indicates limitations on the number of services/products allowed (possibly per time period).  Value should be a Quantity</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-allowed-period\">allowed-period</a></td><td style=\"color: #cccccc\">Maximum allowed period</td><td>Indicates the maximum period of time that can be covered in a single order.  Value should be a Period</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-in-network-copay\">in-network-copay</a></td><td style=\"color: #cccccc\">Copay for in-network</td><td>Indicates a percentage co-pay to expect if delivered in-network.  Value should be a Quantity.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-out-network-copay\">out-network-copay</a></td><td style=\"color: #cccccc\">Copay for out-of-network</td><td>Indicates a percentage co-pay to expect if delivered out-of-network.  Value should be a Quantity.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-auth-out-network-only\">auth-out-network-only</a></td><td style=\"color: #cccccc\">Authorization out-of-network only</td><td>Authorization is only necessary if out-of-network.  Value should be a boolean.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-concurrent-review\">concurrent-review</a></td><td style=\"color: #cccccc\">Concurrent review</td><td>Additional payer-defined documentation will be required prior to claim payment.  Value should be a boolean.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-appropriate-use-needed\">appropriate-use-needed</a></td><td style=\"color: #cccccc\">Appropriate use</td><td>Payer-defined appropriate use process must be invoked to determine coverage.  Value should be a boolean.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-policy-link\">policy-link</a></td><td style=\"color: #cccccc\">Policy Link</td><td>A URL pointing to the specific portion of a payer policy, coverage agreement or similar authoritative document that provides a portion of the basis for the decision documented in the coverage-information.  Value should be a url.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-instructions\">instructions</a></td><td style=\"color: #cccccc\">Instructions</td><td>Information to display to the user that gives guidance about what steps to take in achieving the recommended actions identified by this coverage-information (e.g. special instructions about requesting authorization, details about information needed, details about data retention, etc.).  Value should be a string.</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-instructions-clinical\">instructions-clinical</a></td><td style=\"color: #cccccc\">Clinical instructions</td><td>Instructions specifically intended for the use of clinical (rather than administrative staff)</td></tr><tr><td><a href=\"CodeSystem-temp.html#temp-instructions-admin\">instructions-admin</a></td><td style=\"color: #cccccc\">Administrative Instructions</td><td>Instructions specifically intended for the use of administrative (rather than clinical staff)</td></tr></table></li></ul></div>",
    "status" : "extensions"
  }
}