Generated Narrative: CodeSystem crd-coverage-detail Properties This code system defines the following properties for its concepts Name Code URI Type Not Selectable abstract http://hl7.org/fhir/concept-properties#notSelectable boolean Concepts This case-sensitive code system http://terminology.hl7.org/CodeSystem/crd-coverage-detail defines the following codes in a Is-A hierarchy: Lvl Code Display Definition Not Selectable 1 _limitation Limitation details Identifies detail codes that define limitations of coverage. (Category should be 'cat-limitation') true 2 allowed-quantity Maximum quantity Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity 2 allowed-period Maximum allowed period Indicates the maximum period of time that can be covered in a single order. Value should be a Period 1 _decisional Decisional details Identifies detail codes that may impact patient and clinician decision making (Category should be 'cat-decisional') true 2 in-network-copay Copay for in-network Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity. 2 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. 2 concurrent-review Concurrent review Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean. 2 appropriate-use-needed Appropriate use Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean. 1 _other Other details Identifies detail codes that are generally not relevant to clinicians/patients (Category should be 'cat-other') true 2 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. 1 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.)
Codes that describe additional details related to a coverage information assertion. These live in THO rather than the CRD specification to support adding additional concepts without putting out a new CRD release.
This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license
Identifies detail codes that define limitations of coverage. (Category should be 'cat-limitation')
Indicates limitations on the number of services/products allowed (possibly per time period). Value should be a Quantity
Indicates the maximum period of time that can be covered in a single order. Value should be a Period
Identifies detail codes that may impact patient and clinician decision making (Category should be 'cat-decisional')
Indicates a percentage co-pay to expect if delivered in-network. Value should be a Quantity.
Indicates a percentage co-pay to expect if delivered out-of-network. Value should be a Quantity.
Additional payer-defined documentation will be required prior to claim payment. Value should be a boolean.
Payer-defined appropriate use process must be invoked to determine coverage. Value should be a boolean.
Identifies detail codes that are generally not relevant to clinicians/patients (Category should be 'cat-other')
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.
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.)