FHIRsmith: ValueSet/ValueSet-coverageDetailNew.json

FHIR IG analytics

Package	hl7.fhir.us.davinci-crd
Resource Type	ValueSet
Id	ValueSet-coverageDetailNew.json
FHIR Version	R4
Source	https://build.fhir.org/ig/HL7/davinci-crd/ValueSet-coverageDetailNew.html
URL	http://hl7.org/fhir/us/davinci-crd/ValueSet/coverageDetailNew
Version	2.2.0-snapshot
Status	active
Date	2026-01-30T22:02:38+00:00
Name	CRDCoverageDetailCodesNew
Title	Official CRD Coverage Detail Codes Value Set
Realm	us
Authority	hl7
Description	Codes for name-value-pair details on a coverage assertion - now using official FHIR codes

Resources that use this resource

StructureDefinition
ext-coverage-information	Coverage Information

Resources that this resource uses

CodeSystem
crd-coverage-detail	CRD Coverage Detail Codes

Narrative

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

Generated Narrative: ValueSet coverageDetailNew

Include these codes as defined in http://terminology.hl7.org/CodeSystem/crd-coverage-detail version 📦1.0.0

Code	Display	Definition
allowed-quantity	Maximum quantity	Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity
allowed-period	Maximum allowed period	Indicates the maximum period of time that can be covered in a single order. Value should be a Period
in-network-copay	Copay for in-network	Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity.
out-network-copay	Copay for out-of-network	Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity.
concurrent-review	Concurrent review	Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean.
appropriate-use-needed	Appropriate use	Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean.
policy-link	Policy Link	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.
instructions	Instructions	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.)

Source1

{
  "resourceType": "ValueSet",
  "id": "coverageDetailNew",
  "text": {
    "status": "extensions",
    "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/ValueSet/coverageDetailNew",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:2.16.840.1.113883.4.642.40.18.48.26"
    }
  ],
  "version": "2.2.0-snapshot",
  "name": "CRDCoverageDetailCodesNew",
  "title": "Official CRD Coverage Detail Codes Value Set",
  "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 for name-value-pair details on a coverage assertion - now using official FHIR codes",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US"
        }
      ]
    }
  ],
  "compose": {
    "include": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/crd-coverage-detail",
        "concept": [
          {
            "code": "allowed-quantity"
          },
          {
            "code": "allowed-period"
          },
          {
            "code": "in-network-copay"
          },
          {
            "code": "out-network-copay"
          },
          {
            "code": "concurrent-review"
          },
          {
            "code": "appropriate-use-needed"
          },
          {
            "code": "policy-link"
          },
          {
            "code": "instructions"
          }
        ]
      }
    ]
  }
}