HL7 Terminology (THO)
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HL7 Terminology (THO) - Local Development build (v6.3.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

ValueSet: Medical Management Type

Official URL: http://terminology.hl7.org/ValueSet/medical-management-type Version: 1.0.0
Active as of 2025-05-26 Maturity Level: 1 Responsible: Health Level Seven International Computable Name: MedicalManagementType
Other Identifiers: OID:2.16.840.1.113883.11.21037

Copyright/Legal: 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.html

This value set includes 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.

References

This value set is not used here; it may be used elsewhere (e.g. specifications and/or implementations that use this content)

Logical Definition (CLD)

Last updated: 2025-05-26 00:00:00+0000

Profile: Shareable ValueSet

 

Expansion

Expansion performed internally based on codesystem Medical Management Type v1.0.0 (CodeSystem)

This value set contains 3 concepts

CodeSystemDisplay (en-US)Definition
  concurrent-reviewhttp://terminology.hl7.org/CodeSystem/medical-management-typeConcurrent ReviewReview of medical necessity while the patient is actively receiving treatment.
  prior-authhttp://terminology.hl7.org/CodeSystem/medical-management-typePrior AuthorizationReview of medical necessity prior to receiving treatment.
  step-therapyhttp://terminology.hl7.org/CodeSystem/medical-management-typeStep Therapy (Fail First)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'.

Explanation of the columns that may appear on this page:

Level A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code The code (used as the code in the resource instance)
Display The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition An explanation of the meaning of the concept
Comments Additional notes about how to use the code