medical-management-type
type: CodeSystem
node role: treeRoot
id:
  v: medical-management-type
meta:
  last updated:
    v: 2025-05-26T00:00:00+00:00
  profile:
    v: http://hl7.org/fhir/StructureDefinition/shareablecodesystem
    l: shareablecodesystem
text:
  status:
    v: generated
  div:
    v: Generated Narrative: CodeSystem medical-management-type Last updated: 2025-05-26 00:00:00+0000 Profile: Shareable CodeSystem This case-sensitive code system http://terminology.hl7.org/CodeSystem/medical-management-type defines the following codes: Code Display Definition concurrent-review Concurrent Review Review of medical necessity while the patient is actively receiving treatment. prior-auth Prior Authorization Review of medical necessity prior to receiving treatment. step-therapy Step 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'.
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
    l: structuredefinition-wg
  value: Code
    v: fm
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm
    l: structuredefinition-fmm
  value: Integer
    v: 1
url:
  v: http://terminology.hl7.org/CodeSystem/medical-management-type
  l: medical-management-type
identifier:
  system:
    v: urn:ietf:rfc:3986
    l: 3986
  value:
    v: urn:oid:2.16.840.1.113883.5.175
version:
  v: 1.0.0
name:
  v: MedicalManagementType
title:
  v: Medical Management Type
status:
  v: active
experimental:
  v: false
date:
  v: 2026-02-23T04:46:23+00:00
publisher:
  v: Health Level Seven International
contact:
  telecom:
    system:
      v: url
    value:
      v: http://hl7.org
  telecom:
    system:
      v: email
description:
  v: 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:
  v: 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
case sensitive:
  v: true
value set:
  v: http://terminology.hl7.org/ValueSet/medical-management-type
  l: medical-management-type
content:
  v: complete
concept:
  code:
    v: concurrent-review
  display:
    v: Concurrent Review
  definition:
    v: Review of medical necessity while the patient is actively receiving treatment.
concept:
  code:
    v: prior-auth
  display:
    v: Prior Authorization
  definition:
    v: Review of medical necessity prior to receiving treatment.
concept:
  code:
    v: step-therapy
  display:
    v: Step Therapy (Fail First)
  definition:
    v: 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'.