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Packagehl7.fhir.us.davinci-crd
Resource TypeCodeSystem
IdCodeSystem-temp.json
FHIR VersionR4
Sourcehttps://build.fhir.org/ig/HL7/davinci-crd/CodeSystem-temp.html
URLhttp://hl7.org/fhir/us/davinci-crd/CodeSystem/temp
Version2.2.0-snapshot
Statusactive
Date2026-01-30T22:02:38+00:00
NameCRDTempCodes
TitleCRD Temporary Codes
Realmus
Authorityhl7
DescriptionCodes temporarily defined as part of the CRD implementation guide. These will eventually migrate into an officially maintained terminology (likely either SNOMED CT or HL7's UTG code systems).
Contentcomplete

Resources that use this resource

ConceptMap
HL7Location-CRDTempHL7 Location code to CMS location code
ValueSet
coverageAssertionReasonsCRD Coverage Assertion Reasons Value Set
coverageDetailDeprecated CRD Coverage Detail Codes Value Set
cs-categoriesCRD Conformance Statement Categories
CMSMappableLocationCodesCMS Mappable Location Codes Value Set

Resources that this resource uses

No resources found


Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: CodeSystem temp

Properties

This code system defines the following properties for its concepts

NameCodeURIType
Not Selectableabstracthttp://hl7.org/fhir/concept-properties#notSelectableboolean

Concepts

This case-sensitive code system http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp defines the following codes in a Is-A hierarchy:

LvlCodeDisplayDefinitionNot Selectable
1gold-card Gold cardOrdering Practitioner has been granted 'gold card' status with this payer/coverage type.
1no-member-found Member not foundThe CRD server was unable to find a matching member, so no coverage information can be provided
1no-active-coverage Coverage not activeThe referenced insurance coverage for the member is not active, so no coverage information can be provided
1auth-out-network Authorization needed out-of-networkAuthorization is necessary if out-of-network.
1_limitation Limitation detailsIdentifies detail codes that define limitations of coverage. (Category should be 'cat-limitation')true
2  allowed-quantity Maximum quantityIndicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity
2  allowed-period Maximum allowed periodIndicates the maximum period of time that can be covered in a single order. Value should be a Period
1_decisional Decisional detailsIdentifies detail codes that may impact patient and clinician decision making (Category should be 'cat-decisional')true
2  in-network-copay Copay for in-networkIndicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity.
2  out-network-copay Copay for out-of-networkIndicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity.
2  concurrent-review Concurrent reviewAdditional payer-defined documentation will be required prior to claim payment. Value should be a boolean.
2  appropriate-use-needed Appropriate usePayer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean.
1_other Other detailsIdentifies detail codes that are generally not relevant to clinicians/patients (Category should be 'cat-other')true
2  policy-link Policy LinkA 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.
1instructions InstructionsInformation 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. (Category may vary.)
1_cardType Card Type (abstract)A collector for different profiles on CDS Hooks cardtrue
2  coverage-info Coverage InformationInformation related to the patient's coverage, including whether a service is covered, requires prior authorization, is approved without seeking prior authorization, and/or requires additional documentation or data collection
3    unsolicited-determ Unsolicited DeterminationAn unsolicited approval of the service as having prior authorization requirements met without a formal submission of a prior authorization request
2  claim ClaimInformation about what steps need to be taken to submit a claim for the service
2  insurance InsuranceAllows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)
2  limits LimitsMessages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general
2  network NetworkProviding information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)
2  appropriate-use Appropriate UseGuidance on whether appropriate-use documentation is needed
2  cost CostWhat is the anticipated cost to the patient based on their coverage
2  therapy-alternatives-opt Optional Therapy AlternativesAre there alternative therapies that have better coverage and/or are lower-cost for the patient
2  therapy-alternatives-req Required Therapy AlternativesAre there alternative therapies that must be tried first prior to coverage being available for the proposed therapy
2  clinical-reminder Clinical ReminderReminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)
2  duplicate-therapy Duplicate TherapyNotice that the proposed intervention has already recently occurred with a different provider when that information is not already available in the provider system
2  contraindication ContraindicationNotice that the proposed intervention may be contraindicated based on information the payer has in their record that the provider does not have in theirs
2  guideline GuidelineIndication that there is a guideline available for the proposed therapy (with an option to view)
2  off-guideline Off GuidelineNotice that the proposed therapy may be contrary to best-practice guidelines, typically with an option to view the relevant guideline
1_reqcat Requirements CategoriesCodes that help to categorize requirements statementstrue
2  business businessRequirements relating to the business operations of the entities responsible for a system
2  exchange exchangeRequirements relating to when or how data is exchanged with other systems
2  processing processingRequirements related to how data is dealt with internally to a system
2  storage storageRequirements relating to when or how data is or is not persisted within a system
2  ui uiRequirements relating to the appearance of information on a user interface

Source1

{
  "resourceType": "CodeSystem",
  "id": "temp",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fm"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 4,
      "_valueInteger": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"
          }
        ]
      }
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use",
      "_valueCode": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/davinci-crd/ImplementationGuide/davinci-crd"
          }
        ]
      }
    }
  ],
  "url": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/temp",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.40.18.16.1"
    }
  ],
  "version": "2.2.0-snapshot",
  "name": "CRDTempCodes",
  "title": "CRD Temporary Codes",
  "status": "active",
  "experimental": false,
  "date": "2026-01-30T22:02:38+00:00",
  "publisher": "HL7 International / Financial Management",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/fm"
        }
      ]
    }
  ],
  "description": "Codes temporarily defined as part of the CRD implementation guide.  These will eventually migrate into an officially maintained terminology (likely either SNOMED CT or HL7's UTG code systems).",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US"
        }
      ]
    }
  ],
  "caseSensitive": true,
  "hierarchyMeaning": "is-a",
  "content": "complete",
  "count": 37,
  "property": [
    {
      "code": "abstract",
      "uri": "http://hl7.org/fhir/concept-properties#notSelectable",
      "type": "boolean"
    }
  ],
  "concept": [
    {
      "code": "gold-card",
      "display": "Gold card",
      "definition": "Ordering Practitioner has been granted 'gold card' status with this payer/coverage type."
    },
    {
      "code": "no-member-found",
      "display": "Member not found",
      "definition": "The CRD server was unable to find a matching member, so no coverage information can be provided"
    },
    {
      "code": "no-active-coverage",
      "display": "Coverage not active",
      "definition": "The referenced insurance coverage for the member is not active, so no coverage information can be provided"
    },
    {
      "code": "auth-out-network",
      "display": "Authorization needed out-of-network",
      "definition": "Authorization is necessary if out-of-network."
    },
    {
      "code": "_limitation",
      "display": "Limitation details",
      "definition": "Identifies detail codes that define limitations of coverage.  (Category should be 'cat-limitation')",
      "property": [
        {
          "code": "abstract",
          "valueBoolean": true
        }
      ],
      "concept": [
        {
          "code": "allowed-quantity",
          "display": "Maximum quantity",
          "definition": "Indicates limitations on the number of services/products allowed (possibly per time period).  Value should be a Quantity"
        },
        {
          "code": "allowed-period",
          "display": "Maximum allowed period",
          "definition": "Indicates the maximum period of time that can be covered in a single order.  Value should be a Period"
        }
      ]
    },
    {
      "code": "_decisional",
      "display": "Decisional details",
      "definition": "Identifies detail codes that may impact patient and clinician decision making  (Category should be 'cat-decisional')",
      "property": [
        {
          "code": "abstract",
          "valueBoolean": true
        }
      ],
      "concept": [
        {
          "code": "in-network-copay",
          "display": "Copay for in-network",
          "definition": "Indicates a percentage co-pay to expect if delivered in-network.  Value should be a Quantity."
        },
        {
          "code": "out-network-copay",
          "display": "Copay for out-of-network",
          "definition": "Indicates a percentage co-pay to expect if delivered out-of-network.  Value should be a Quantity."
        },
        {
          "code": "concurrent-review",
          "display": "Concurrent review",
          "definition": "Additional payer-defined documentation will be required prior to claim payment.  Value should be a boolean."
        },
        {
          "code": "appropriate-use-needed",
          "display": "Appropriate use",
          "definition": "Payer-defined appropriate use process must be invoked to determine coverage.  Value should be a boolean."
        }
      ]
    },
    {
      "code": "_other",
      "display": "Other details",
      "definition": "Identifies detail codes that are generally not relevant to clinicians/patients  (Category should be 'cat-other')",
      "property": [
        {
          "code": "abstract",
          "valueBoolean": true
        }
      ],
      "concept": [
        {
          "code": "policy-link",
          "display": "Policy Link",
          "definition": "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."
        }
      ]
    },
    {
      "code": "instructions",
      "display": "Instructions",
      "definition": "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.  (Category may vary.)"
    },
    {
      "code": "_cardType",
      "display": "Card Type (abstract)",
      "definition": "A collector for different profiles on CDS Hooks card",
      "property": [
        {
          "code": "abstract",
          "valueBoolean": true
        }
      ],
      "concept": [
        {
          "code": "coverage-info",
          "display": "Coverage Information",
          "definition": "Information related to the patient's coverage, including whether a service is covered, requires prior authorization, is approved without seeking prior authorization, and/or requires additional documentation or data collection",
          "concept": [
            {
              "code": "unsolicited-determ",
              "display": "Unsolicited Determination",
              "definition": "An unsolicited approval of the service as having prior authorization requirements met without a formal submission of a prior authorization request"
            }
          ]
        },
        {
          "code": "claim",
          "display": "Claim",
          "definition": "Information about what steps need to be taken to submit a claim for the service"
        },
        {
          "code": "insurance",
          "display": "Insurance",
          "definition": "Allows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)"
        },
        {
          "code": "limits",
          "display": "Limits",
          "definition": "Messages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general"
        },
        {
          "code": "network",
          "display": "Network",
          "definition": "Providing information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)"
        },
        {
          "code": "appropriate-use",
          "display": "Appropriate Use",
          "definition": "Guidance on whether appropriate-use documentation is needed"
        },
        {
          "code": "cost",
          "display": "Cost",
          "definition": "What is the anticipated cost to the patient based on their coverage"
        },
        {
          "code": "therapy-alternatives-opt",
          "display": "Optional Therapy Alternatives",
          "definition": "Are there alternative therapies that have better coverage and/or are lower-cost for the patient"
        },
        {
          "code": "therapy-alternatives-req",
          "display": "Required Therapy Alternatives",
          "definition": "Are there alternative therapies that must be tried first prior to coverage being available for the proposed therapy"
        },
        {
          "code": "clinical-reminder",
          "display": "Clinical Reminder",
          "definition": "Reminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)"
        },
        {
          "code": "duplicate-therapy",
          "display": "Duplicate Therapy",
          "definition": "Notice that the proposed intervention has already recently occurred with a different provider when that information is not already available in the provider system"
        },
        {
          "code": "contraindication",
          "display": "Contraindication",
          "definition": "Notice that the proposed intervention may be contraindicated based on information the payer has in their record that the provider does not have in theirs"
        },
        {
          "code": "guideline",
          "display": "Guideline",
          "definition": "Indication that there is a guideline available for the proposed therapy (with an option to view)"
        },
        {
          "code": "off-guideline",
          "display": "Off Guideline",
          "definition": "Notice that the proposed therapy may be contrary to best-practice guidelines, typically with an option to view the relevant guideline"
        }
      ]
    },
    {
      "code": "_reqcat",
      "display": "Requirements Categories",
      "definition": "Codes that help to categorize requirements statements",
      "property": [
        {
          "code": "abstract",
          "valueBoolean": true
        }
      ],
      "concept": [
        {
          "code": "business",
          "display": "business",
          "definition": "Requirements relating to the business operations of the entities responsible for a system"
        },
        {
          "code": "exchange",
          "display": "exchange",
          "definition": "Requirements relating to when or how data is exchanged with other systems"
        },
        {
          "code": "processing",
          "display": "processing",
          "definition": "Requirements related to how data is dealt with internally to a system"
        },
        {
          "code": "storage",
          "display": "storage",
          "definition": "Requirements relating to when or how data is or is not persisted within a system"
        },
        {
          "code": "ui",
          "display": "ui",
          "definition": "Requirements relating to the appearance of information on a user interface"
        }
      ]
    }
  ]
}