HL7 Terminology (THO)
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: Medical Management Type - XML Representation

Active as of 2025-06-10 Maturity Level: 1

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="medical-management-type"/>
  <meta>
    <lastUpdated value="2025-05-26T00:00:00+00:00"/>
    <profile
             value="http://hl7.org/fhir/StructureDefinition/shareablecodesystem"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem medical-management-type</b></p><a name="medical-management-type"> </a><a name="hcmedical-management-type"> </a><a name="medical-management-type-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Last updated: 2025-05-26 00:00:00+0000</p><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/R5/shareablecodesystem.html">Shareable CodeSystem</a></p></div><p>This case-sensitive code system <code>http://terminology.hl7.org/CodeSystem/medical-management-type</code> defines the following codes:</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap">concurrent-review<a name="medical-management-type-concurrent-review"> </a></td><td>Concurrent Review</td><td>Review of medical necessity while the patient is actively receiving treatment.</td></tr><tr><td style="white-space:nowrap">prior-auth<a name="medical-management-type-prior-auth"> </a></td><td>Prior Authorization</td><td>Review of medical necessity prior to receiving treatment.</td></tr><tr><td style="white-space:nowrap">step-therapy<a name="medical-management-type-step-therapy"> </a></td><td>Step Therapy (Fail First)</td><td>Requirement that lower cost or preferred treatments be tried, or perhaps contra-indicated, before alternatives are utilized. This policy is sometimes referred to as 'fail first'.</td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="fm"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="1"/>
  </extension>
  <url value="http://terminology.hl7.org/CodeSystem/medical-management-type"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.5.175"/>
  </identifier>
  <version value="1.0.0"/>
  <name value="MedicalManagementType"/>
  <title value="Medical Management Type"/>
  <status value="active"/>
  <experimental value="false"/>
  <date value="2025-06-10T22:08:54+00:00"/>
  <publisher value="Health Level Seven International"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://hl7.org"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="hq@HL7.org"/>
    </telecom>
  </contact>
  <description
               value="Types of medical management requirements or processes used by health insurers (payers) that may impact whether a service or item is covered or reimbursement rates."/>
  <copyright
             value="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"/>
  <caseSensitive value="true"/>
  <valueSet
            value="http://terminology.hl7.org/ValueSet/medical-managment-type"/>
  <content value="complete"/>
  <concept>
    <code value="concurrent-review"/>
    <display value="Concurrent Review"/>
    <definition
                value="Review of medical necessity while the patient is actively receiving treatment."/>
  </concept>
  <concept>
    <code value="prior-auth"/>
    <display value="Prior Authorization"/>
    <definition
                value="Review of medical necessity prior to receiving treatment."/>
  </concept>
  <concept>
    <code value="step-therapy"/>
    <display value="Step Therapy (Fail First)"/>
    <definition
                value="Requirement that lower cost or preferred treatments be tried, or perhaps contra-indicated, before alternatives are utilized. This policy is sometimes referred to as 'fail first'."/>
  </concept>
</CodeSystem>