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FHIR IG Statistics: ValueSet/coveragePaDetail

Packagehl7.fhir.us.davinci-crd
TypeValueSet
IdcoveragePaDetail
FHIR VersionR4
Sourcehttp://hl7.org/fhir/us/davinci-crd/https://build.fhir.org/ig/HL7/davinci-crd/ValueSet-coveragePaDetail.html
URLhttp://hl7.org/fhir/us/davinci-crd/ValueSet/coveragePaDetail
Version2.2.0-ballot
Statusactive
Date2025-07-22T17:00:27+00:00
NameCRDCoveragePaDetail
TitleCRD Coverage Information Prior Authorization Value Set
Realmus
Authorityhl7
DescriptionCodes defining whether prior auth will be needed for coverage to be provided

Resources that use this resource

StructureDefinition
CRDMetricDataCRD Metric Data
ext-coverage-informationCoverage Information
DTRMetricDataDTR Metric Data

Resources that this resource uses

CodeSystem
coverage-information-codesCoverage Information Codes

Narrative

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

Generated Narrative: ValueSet coveragePaDetail

  • Include these codes as defined in http://hl7.org/fhir/us/davinci-crd/CodeSystem/coverage-information-codes
    CodeDisplayDefinition
    no-authNo Prior AuthorizationThe ordered service does not require prior authorization
    auth-neededPrior Authorization NeededThe ordered service will require prior authorization
    satisfiedAuthorization SatisfiedWhile prior authorization would typically be needed, the conditions evaluated by prior authorization have already been evaluated and therefore prior authorization can be bypassed
    performpaPerformer Prior AuthorizationPrior authorization is needed for the service, however such prior authoriation must be initiated by the performing (rather than ordering) provider.
    conditionalConditionalThere 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": "2025-07-22T17:00:27+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"
          }
        ]
      }
    ]
  }
}