description: Captures assertions from a payer about the coverage rules for a service - in particular, whether it is covered and/or requires prior authorization.
package_name: hl7.fhir.us.davinci-crd
derivation: constraint
name: CRDCoverageInformation
type: Extension
elements:
  extension:
    array: true
    min: 4
    index: 0
    slicing:
      slices:
        coverage-assertion-id:
          match: {}
          schema:
            short: Coverage assertion trace number
            mustSupport: true
            _required: true
            index: 100
            extensions: {}
            elements:
              extension: {index: 101}
              url:
                pattern: {type: uri, value: coverage-assertion-id}
                type: uri
                index: 102
              value:
                choices: [valueString]
                index: 104
              valueString: {type: string, choiceOf: value, index: 105}
        date:
          match: {}
          schema:
            short: Assertion date
            mustSupport: true
            _required: true
            index: 94
            extensions: {}
            elements:
              extension: {index: 95}
              url:
                pattern: {type: uri, value: date}
                type: uri
                index: 96
              value:
                choices: [valueDate]
                index: 98
              valueDate: {type: date, choiceOf: value, index: 99}
            required: [value, valueDate]
        dependency:
          match: {}
          schema:
            short: Resources that impact this assertion
            mustSupport: true
            array: true
            index: 82
            extensions: {}
            elements:
              extension: {index: 83}
              url:
                pattern: {type: uri, value: dependency}
                type: uri
                index: 84
              value:
                choices: [valueReference]
                index: 86
              valueReference:
                type: Reference
                choiceOf: value
                refers: ['http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment-no-order', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment-with-order', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-communicationrequest', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-devicerequest', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-nutritionorder', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-servicerequest']
                index: 87
        questionnaire:
          match: {}
          schema:
            short: Questionnaire to complete
            mustSupport: true
            array: true
            index: 88
            extensions: {}
            elements:
              extension: {index: 89}
              url:
                pattern: {type: uri, value: questionnaire}
                type: uri
                index: 90
              value:
                choices: [valueCanonical]
                index: 92
              valueCanonical: {type: canonical, choiceOf: value, index: 93}
        expiry-date:
          match: {}
          schema:
            short: Expiration date
            mustSupport: true
            index: 118
            extensions: {}
            elements:
              extension: {index: 119}
              url:
                pattern: {type: uri, value: expiry-date}
                type: uri
                index: 120
              value:
                choices: [valueDate]
                index: 122
              valueDate: {type: date, choiceOf: value, index: 123}
        pa-needed:
          match: {}
          schema:
            short: no-auth | auth-needed | satisfied | performpa | conditional
            mustSupport: true
            index: 13
            extensions: {}
            elements:
              extension: {index: 14}
              url:
                pattern: {type: uri, value: pa-needed}
                type: uri
                index: 15
              value:
                choices: [valueCode]
                index: 17
              valueCode: {type: code, choiceOf: value, index: 18}
            required: [value, valueCode]
        coverage:
          match: {}
          schema:
            short: Reference to Coverage
            mustSupport: true
            _required: true
            index: 1
            extensions: {}
            elements:
              extension: {index: 2}
              url:
                pattern: {type: uri, value: coverage}
                type: uri
                index: 3
              value:
                choices: [valueReference]
                index: 5
              valueReference:
                type: Reference
                choiceOf: value
                refers: ['http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage']
                index: 6
            required: [value, valueReference]
        doc-needed:
          match: {}
          schema:
            short: clinical | admin | patient | conditional
            mustSupport: true
            array: true
            index: 19
            extensions: {}
            elements:
              extension: {index: 20}
              url:
                pattern: {type: uri, value: doc-needed}
                type: uri
                index: 21
              value:
                choices: [valueCode]
                index: 23
              valueCode: {type: code, choiceOf: value, index: 24}
            required: [value, valueCode]
        reason:
          match: {}
          schema:
            short: Reason for assertion
            mustSupport: true
            array: true
            index: 43
            extensions: {}
            elements:
              extension: {index: 44}
              url:
                pattern: {type: uri, value: reason}
                type: uri
                index: 45
              value:
                choices: [valueCodeableConcept]
                index: 47
              valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 48}
            required: [value, valueCodeableConcept]
        satisfied-pa-id:
          match: {}
          schema:
            short: Satisfied prior auth number
            mustSupport: true
            index: 106
            extensions: {}
            elements:
              extension: {index: 107}
              url:
                pattern: {type: uri, value: satisfied-pa-id}
                type: uri
                index: 108
              value:
                choices: [valueString]
                index: 110
              valueString: {type: string, choiceOf: value, index: 111}
        doc-purpose:
          match: {}
          schema:
            short: withpa | withclaim | withorder | retain-doc | OTH
            mustSupport: true
            array: true
            index: 25
            extensions: {}
            elements:
              extension: {index: 26}
              url:
                pattern: {type: uri, value: doc-purpose}
                type: uri
                index: 27
              value:
                choices: [valueCode]
                index: 29
              valueCode: {type: code, choiceOf: value, index: 30}
            required: [value, valueCode]
        contact:
          match: {}
          schema:
            short: Contact information
            mustSupport: true
            array: true
            index: 112
            extensions: {}
            elements:
              extension: {index: 113}
              url:
                pattern: {type: uri, value: contact}
                type: uri
                index: 114
              value:
                choices: [valueContactPoint]
                index: 116
              valueContactPoint: {type: ContactPoint, choiceOf: value, index: 117}
        info-needed:
          match: {}
          schema:
            short: performer | location | timeframe | contract-window | detail-code | OTH
            mustSupport: true
            array: true
            index: 31
            extensions: {}
            elements:
              extension: {index: 32}
              url:
                pattern: {type: uri, value: info-needed}
                type: uri
                index: 33
              value:
                choices: [valueCode]
                index: 35
              valueCode: {type: code, choiceOf: value, index: 36}
            required: [value, valueCode]
        covered:
          match: {}
          schema:
            short: covered | not-covered | conditional
            mustSupport: true
            _required: true
            index: 7
            extensions: {}
            elements:
              extension: {index: 8}
              url:
                pattern: {type: uri, value: covered}
                type: uri
                index: 9
              value:
                choices: [valueCode]
                index: 11
              valueCode: {type: code, choiceOf: value, index: 12}
            required: [value, valueCode]
        billingCode:
          match: {}
          schema:
            short: Billing code
            mustSupport: true
            array: true
            index: 37
            extensions: {}
            elements:
              extension: {index: 38}
              url:
                pattern: {type: uri, value: billingCode}
                type: uri
                index: 39
              value:
                choices: [valueCoding]
                index: 41
              valueCoding: {type: Coding, choiceOf: value, index: 42}
            required: [value, valueCoding]
        detail:
          match: {}
          schema:
            short: detail for assertion
            mustSupport: true
            array: true
            index: 49
            extensions:
              category:
                url: null
                short: Type of detail
                _required: true
                index: 51
                extensions: {}
                elements:
                  extension: {index: 52}
                  url:
                    pattern: {type: uri, value: category}
                    type: uri
                    index: 53
                  value:
                    choices: [valueCode]
                    index: 55
                  valueCode: {type: code, choiceOf: value, index: 56}
              code:
                url: null
                short: Name of name-value pair
                _required: true
                index: 57
                extensions: {}
                elements:
                  extension: {index: 58}
                  url:
                    pattern: {type: uri, value: code}
                    type: uri
                    index: 59
                  value:
                    choices: [valueCodeableConcept]
                    index: 61
                  valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 62}
              value:
                url: null
                short: Value of name-value pair
                _required: true
                index: 63
                extensions: {}
                elements:
                  extension: {index: 64}
                  url:
                    pattern: {type: uri, value: value}
                    type: uri
                    index: 65
                  value:
                    choices: [valueBoolean, valueString, valueUrl, valuePeriod, valueQuantity]
                    index: 67
                  valueBoolean: {type: boolean, choiceOf: value, index: 68}
                  valueString: {type: string, choiceOf: value, index: 69}
                  valueUrl: {type: url, choiceOf: value, index: 70}
                  valuePeriod: {type: Period, choiceOf: value, index: 71}
                  valueQuantity: {type: Quantity, choiceOf: value, index: 72}
              qualification:
                url: null
                short: Additional info about detail
                index: 73
                extensions: {}
                elements:
                  extension: {index: 74}
                  url:
                    pattern: {type: uri, value: qualification}
                    type: uri
                    index: 75
                  value:
                    choices: [valueString]
                    index: 77
                  valueString: {type: string, choiceOf: value, index: 78}
            elements:
              extension:
                array: true
                min: 3
                index: 50
                slicing:
                  slices:
                    category:
                      match: {}
                      schema:
                        short: Type of detail
                        _required: true
                        index: 51
                        extensions: {}
                        elements:
                          extension: {index: 52}
                          url:
                            pattern: {type: uri, value: category}
                            type: uri
                            index: 53
                          value:
                            choices: [valueCode]
                            index: 55
                          valueCode: {type: code, choiceOf: value, index: 56}
                    code:
                      match: {}
                      schema:
                        short: Name of name-value pair
                        _required: true
                        index: 57
                        extensions: {}
                        elements:
                          extension: {index: 58}
                          url:
                            pattern: {type: uri, value: code}
                            type: uri
                            index: 59
                          value:
                            choices: [valueCodeableConcept]
                            index: 61
                          valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 62}
                    value:
                      match: {}
                      schema:
                        short: Value of name-value pair
                        _required: true
                        index: 63
                        extensions: {}
                        elements:
                          extension: {index: 64}
                          url:
                            pattern: {type: uri, value: value}
                            type: uri
                            index: 65
                          value:
                            choices: [valueBoolean, valueString, valueUrl, valuePeriod, valueQuantity]
                            index: 67
                          valueBoolean: {type: boolean, choiceOf: value, index: 68}
                          valueString: {type: string, choiceOf: value, index: 69}
                          valueUrl: {type: url, choiceOf: value, index: 70}
                          valuePeriod: {type: Period, choiceOf: value, index: 71}
                          valueQuantity: {type: Quantity, choiceOf: value, index: 72}
                    qualification:
                      match: {}
                      schema:
                        short: Additional info about detail
                        index: 73
                        extensions: {}
                        elements:
                          extension: {index: 74}
                          url:
                            pattern: {type: uri, value: qualification}
                            type: uri
                            index: 75
                          value:
                            choices: [valueString]
                            index: 77
                          valueString: {type: string, choiceOf: value, index: 78}
              url:
                pattern: {type: uri, value: detail}
                type: uri
                index: 79
              value:
                choices: []
                index: 81
  url:
    pattern: {type: uri, value: 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information'}
    type: uri
    index: 124
  value:
    choices: []
    index: 126
package_version: 2.2.0-ballot
extensions:
  coverage-assertion-id:
    url: null
    short: Coverage assertion trace number
    mustSupport: true
    _required: true
    index: 100
    extensions: {}
    elements:
      extension: {index: 101}
      url:
        pattern: {type: uri, value: coverage-assertion-id}
        type: uri
        index: 102
      value:
        choices: [valueString]
        index: 104
      valueString: {type: string, choiceOf: value, index: 105}
  date:
    url: null
    short: Assertion date
    mustSupport: true
    _required: true
    index: 94
    extensions: {}
    elements:
      extension: {index: 95}
      url:
        pattern: {type: uri, value: date}
        type: uri
        index: 96
      value:
        choices: [valueDate]
        index: 98
      valueDate: {type: date, choiceOf: value, index: 99}
    required: [value, valueDate]
  dependency:
    url: null
    short: Resources that impact this assertion
    mustSupport: true
    array: true
    index: 82
    extensions: {}
    elements:
      extension: {index: 83}
      url:
        pattern: {type: uri, value: dependency}
        type: uri
        index: 84
      value:
        choices: [valueReference]
        index: 86
      valueReference:
        type: Reference
        choiceOf: value
        refers: ['http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment-no-order', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-appointment-with-order', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-communicationrequest', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-devicerequest', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-medicationrequest', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-nutritionorder', 'http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-servicerequest']
        index: 87
  questionnaire:
    url: null
    short: Questionnaire to complete
    mustSupport: true
    array: true
    index: 88
    extensions: {}
    elements:
      extension: {index: 89}
      url:
        pattern: {type: uri, value: questionnaire}
        type: uri
        index: 90
      value:
        choices: [valueCanonical]
        index: 92
      valueCanonical: {type: canonical, choiceOf: value, index: 93}
  expiry-date:
    url: null
    short: Expiration date
    mustSupport: true
    index: 118
    extensions: {}
    elements:
      extension: {index: 119}
      url:
        pattern: {type: uri, value: expiry-date}
        type: uri
        index: 120
      value:
        choices: [valueDate]
        index: 122
      valueDate: {type: date, choiceOf: value, index: 123}
  pa-needed:
    url: null
    short: no-auth | auth-needed | satisfied | performpa | conditional
    mustSupport: true
    index: 13
    extensions: {}
    elements:
      extension: {index: 14}
      url:
        pattern: {type: uri, value: pa-needed}
        type: uri
        index: 15
      value:
        choices: [valueCode]
        index: 17
      valueCode: {type: code, choiceOf: value, index: 18}
    required: [value, valueCode]
  coverage:
    url: null
    short: Reference to Coverage
    mustSupport: true
    _required: true
    index: 1
    extensions: {}
    elements:
      extension: {index: 2}
      url:
        pattern: {type: uri, value: coverage}
        type: uri
        index: 3
      value:
        choices: [valueReference]
        index: 5
      valueReference:
        type: Reference
        choiceOf: value
        refers: ['http://hl7.org/fhir/us/davinci-crd/StructureDefinition/profile-coverage']
        index: 6
    required: [value, valueReference]
  doc-needed:
    url: null
    short: clinical | admin | patient | conditional
    mustSupport: true
    array: true
    index: 19
    extensions: {}
    elements:
      extension: {index: 20}
      url:
        pattern: {type: uri, value: doc-needed}
        type: uri
        index: 21
      value:
        choices: [valueCode]
        index: 23
      valueCode: {type: code, choiceOf: value, index: 24}
    required: [value, valueCode]
  reason:
    url: null
    short: Reason for assertion
    mustSupport: true
    array: true
    index: 43
    extensions: {}
    elements:
      extension: {index: 44}
      url:
        pattern: {type: uri, value: reason}
        type: uri
        index: 45
      value:
        choices: [valueCodeableConcept]
        index: 47
      valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 48}
    required: [value, valueCodeableConcept]
  satisfied-pa-id:
    url: null
    short: Satisfied prior auth number
    mustSupport: true
    index: 106
    extensions: {}
    elements:
      extension: {index: 107}
      url:
        pattern: {type: uri, value: satisfied-pa-id}
        type: uri
        index: 108
      value:
        choices: [valueString]
        index: 110
      valueString: {type: string, choiceOf: value, index: 111}
  doc-purpose:
    url: null
    short: withpa | withclaim | withorder | retain-doc | OTH
    mustSupport: true
    array: true
    index: 25
    extensions: {}
    elements:
      extension: {index: 26}
      url:
        pattern: {type: uri, value: doc-purpose}
        type: uri
        index: 27
      value:
        choices: [valueCode]
        index: 29
      valueCode: {type: code, choiceOf: value, index: 30}
    required: [value, valueCode]
  contact:
    url: null
    short: Contact information
    mustSupport: true
    array: true
    index: 112
    extensions: {}
    elements:
      extension: {index: 113}
      url:
        pattern: {type: uri, value: contact}
        type: uri
        index: 114
      value:
        choices: [valueContactPoint]
        index: 116
      valueContactPoint: {type: ContactPoint, choiceOf: value, index: 117}
  info-needed:
    url: null
    short: performer | location | timeframe | contract-window | detail-code | OTH
    mustSupport: true
    array: true
    index: 31
    extensions: {}
    elements:
      extension: {index: 32}
      url:
        pattern: {type: uri, value: info-needed}
        type: uri
        index: 33
      value:
        choices: [valueCode]
        index: 35
      valueCode: {type: code, choiceOf: value, index: 36}
    required: [value, valueCode]
  covered:
    url: null
    short: covered | not-covered | conditional
    mustSupport: true
    _required: true
    index: 7
    extensions: {}
    elements:
      extension: {index: 8}
      url:
        pattern: {type: uri, value: covered}
        type: uri
        index: 9
      value:
        choices: [valueCode]
        index: 11
      valueCode: {type: code, choiceOf: value, index: 12}
    required: [value, valueCode]
  billingCode:
    url: null
    short: Billing code
    mustSupport: true
    array: true
    index: 37
    extensions: {}
    elements:
      extension: {index: 38}
      url:
        pattern: {type: uri, value: billingCode}
        type: uri
        index: 39
      value:
        choices: [valueCoding]
        index: 41
      valueCoding: {type: Coding, choiceOf: value, index: 42}
    required: [value, valueCoding]
  detail:
    url: null
    short: detail for assertion
    mustSupport: true
    array: true
    index: 49
    extensions:
      category:
        url: null
        short: Type of detail
        _required: true
        index: 51
        extensions: {}
        elements:
          extension: {index: 52}
          url:
            pattern: {type: uri, value: category}
            type: uri
            index: 53
          value:
            choices: [valueCode]
            index: 55
          valueCode: {type: code, choiceOf: value, index: 56}
      code:
        url: null
        short: Name of name-value pair
        _required: true
        index: 57
        extensions: {}
        elements:
          extension: {index: 58}
          url:
            pattern: {type: uri, value: code}
            type: uri
            index: 59
          value:
            choices: [valueCodeableConcept]
            index: 61
          valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 62}
      value:
        url: null
        short: Value of name-value pair
        _required: true
        index: 63
        extensions: {}
        elements:
          extension: {index: 64}
          url:
            pattern: {type: uri, value: value}
            type: uri
            index: 65
          value:
            choices: [valueBoolean, valueString, valueUrl, valuePeriod, valueQuantity]
            index: 67
          valueBoolean: {type: boolean, choiceOf: value, index: 68}
          valueString: {type: string, choiceOf: value, index: 69}
          valueUrl: {type: url, choiceOf: value, index: 70}
          valuePeriod: {type: Period, choiceOf: value, index: 71}
          valueQuantity: {type: Quantity, choiceOf: value, index: 72}
      qualification:
        url: null
        short: Additional info about detail
        index: 73
        extensions: {}
        elements:
          extension: {index: 74}
          url:
            pattern: {type: uri, value: qualification}
            type: uri
            index: 75
          value:
            choices: [valueString]
            index: 77
          valueString: {type: string, choiceOf: value, index: 78}
    elements:
      extension:
        array: true
        min: 3
        index: 50
        slicing:
          slices:
            category:
              match: {}
              schema:
                short: Type of detail
                _required: true
                index: 51
                extensions: {}
                elements:
                  extension: {index: 52}
                  url:
                    pattern: {type: uri, value: category}
                    type: uri
                    index: 53
                  value:
                    choices: [valueCode]
                    index: 55
                  valueCode: {type: code, choiceOf: value, index: 56}
            code:
              match: {}
              schema:
                short: Name of name-value pair
                _required: true
                index: 57
                extensions: {}
                elements:
                  extension: {index: 58}
                  url:
                    pattern: {type: uri, value: code}
                    type: uri
                    index: 59
                  value:
                    choices: [valueCodeableConcept]
                    index: 61
                  valueCodeableConcept: {type: CodeableConcept, choiceOf: value, index: 62}
            value:
              match: {}
              schema:
                short: Value of name-value pair
                _required: true
                index: 63
                extensions: {}
                elements:
                  extension: {index: 64}
                  url:
                    pattern: {type: uri, value: value}
                    type: uri
                    index: 65
                  value:
                    choices: [valueBoolean, valueString, valueUrl, valuePeriod, valueQuantity]
                    index: 67
                  valueBoolean: {type: boolean, choiceOf: value, index: 68}
                  valueString: {type: string, choiceOf: value, index: 69}
                  valueUrl: {type: url, choiceOf: value, index: 70}
                  valuePeriod: {type: Period, choiceOf: value, index: 71}
                  valueQuantity: {type: Quantity, choiceOf: value, index: 72}
            qualification:
              match: {}
              schema:
                short: Additional info about detail
                index: 73
                extensions: {}
                elements:
                  extension: {index: 74}
                  url:
                    pattern: {type: uri, value: qualification}
                    type: uri
                    index: 75
                  value:
                    choices: [valueString]
                    index: 77
                  valueString: {type: string, choiceOf: value, index: 78}
      url:
        pattern: {type: uri, value: detail}
        type: uri
        index: 79
      value:
        choices: []
        index: 81
class: extension
kind: complex-type
url: http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information
base: http://hl7.org/fhir/StructureDefinition/Extension
version: 2.2.0-ballot