FHIR IG Statistics: ValueSet/coveragePaDetail
Resources that use this resource
Resources that this resource uses
Narrative
Note: links and images are rebased to the (stated) source
- Include these codes as defined in
http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes| Code | Display | Definition |
| no-auth | No Prior Authorization | The ordered service does not require prior authorization |
| auth-needed | Prior Authorization Needed | The ordered service will require prior authorization |
| satisfied | Authorization Satisfied | While prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed |
| performpa | Performer Prior Authorization | Prior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider. |
| conditional | Conditional | 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.) |
Source
{
"resourceType": "ValueSet",
"id": "coveragePaDetail",
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode": "fm"
},
{
"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/coveragePaDetail",
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "urn:oid:2.16.840.1.113883.4.642.40.18.48.14"
}
],
"version": "2.2.0-ballot",
"name": "CRDCoveragePaDetail",
"title": "CRD Coverage Information Prior Authorization Value Set",
"status": "active",
"experimental": false,
"date": "2025-07-24T20:02:44+00:00",
"publisher": "HL7 International / Financial Management",
"contact": [
{
"telecom": [
{
"system": "url",
"value": "http://www.hl7.org/Special/committees/fm"
}
]
}
],
"description": "Codes defining whether prior auth will be needed for coverage to be provided",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "US"
}
]
}
],
"compose": {
"include": [
{
"system": "http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes",
"concept": [
{
"code": "no-auth"
},
{
"code": "auth-needed"
},
{
"code": "satisfied"
},
{
"code": "performpa"
},
{
"code": "conditional"
}
]
}
]
}
}
FHIR