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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Highest Highest
    • US Da Vinci CRD (FHIR)
    • 1.1.0-ballot [deprecated]
    • Financial Mgmt
    • STU
    • Artifact List
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      Includes FHIR-36471 which was incorrectly withdrawn. 

      Update the ext-coverage-information extension to have a 0..* 'detail' component with a name-value pair

      'detail' - Additional information that qualifies, describes, or provides additional guidance about coverage or documentation requirements

      'code' - 1..1 CodeableConcept - The type of detail or qualification expressed

      'value' - 1..1 string, SimpleQuantity, Period, boolean - the detail or qualification that applies to this order

      'qualification' 0..1 string - additional text that qualifies/expands on the coded value.  (Only permitted if value is not a string)

      Extensible value set for codes:

      allowed-quantity - Indicates limitations on the number of services/products allowed (possibly per time period).  Value should be a Quantity

      allowed-period - Indicates the maximum period of time that can be covered in a single order.  Value should be a Period

      in-network-copay - Indicates a percentage co-pay to expect if delivered in-network.  Value should be a Quantity.

      out-network-copay - Indicates a percentage co-pay to expect if delivered out-of-network.  Value should be a Quantity.

      auth-out-network-only - Authorization is only necessary if out-of-network.  Value should be a boolean.

      concurrent-review - Additional payer-defined documentation will be required prior to claim payment.  Value should be a boolean.

      appropriate-use - Payer-defined appropriate use process must be invoked to determine coverage.  Value should be a boolean.

       

      Will update in the overview the fact that CRD allows payers to convey discrete coverage expectations and attach them to the order.

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      Includes FHIR-36471 which was incorrectly withdrawn.  Update the ext-coverage-information extension to have a 0..* 'detail' component with a name-value pair 'detail' - Additional information that qualifies, describes, or provides additional guidance about coverage or documentation requirements 'code' - 1..1 CodeableConcept - The type of detail or qualification expressed 'value' - 1..1 string, SimpleQuantity, Period, boolean - the detail or qualification that applies to this order 'qualification' 0..1 string - additional text that qualifies/expands on the coded value.  (Only permitted if value is not a string) Extensible value set for codes: allowed-quantity - Indicates limitations on the number of services/products allowed (possibly per time period).  Value should be a Quantity allowed-period - Indicates the maximum period of time that can be covered in a single order.  Value should be a Period in-network-copay - Indicates a percentage co-pay to expect if delivered in-network.  Value should be a Quantity. out-network-copay - Indicates a percentage co-pay to expect if delivered out-of-network.  Value should be a Quantity. auth-out-network-only - Authorization is only necessary if out-of-network.  Value should be a boolean. concurrent-review - Additional payer-defined documentation will be required prior to claim payment.  Value should be a boolean. appropriate-use - Payer-defined appropriate use process must be invoked to determine coverage.  Value should be a boolean.   Will update in the overview the fact that CRD allows payers to convey discrete coverage expectations and attach them to the order.
    • Bob Dieterle / Jeff Brown : 22-0-1
    • Enhancement
    • Non-compatible

    Description

      Do codes need to be added for other restrictions – like concurrent review needed, quantity limits, etc?

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            Unassigned Unassigned
            celine_lefebvre Celine Lefebvre
            Celine Lefebvre
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              Updated:
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