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TX: CodeSystem cdshooks-card-type

Properties

Defining URL http://terminology.hl7.org/CodeSystem/cdshooks-card-type
Version 1.0.0
Name CDSHooksCardType
Title CDS Hooks Card Types
Status active
Definition

Codes defining types of cards that can potentially be returned by a decision support service. The initial set of codes is biased towards those related to insurance coverage, but all types of response types are acceptable in the code system.
Publisher Health Level Seven International
Committee fm
Copyright 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
EXT_FMM_LEVEL 1
Source hl7.terminology.r4#7.3.0

This case-sensitive code system http://terminology.hl7.org/CodeSystem/cdshooks-card-type defines the following codes in a is-a hierarchy:

Level Code Display Definition
1 coverage-info Coverage Information Information related to the patient's coverage, including whether a service is covered, requires prior authorization, is approved without seeking prior authorization, and/or requires additional documentation or data collection
2   unsolicited-determ Unsolicited Determination An unsolicited approval of the service as having prior authorization requirements met without a formal submission of a prior authorization request
1 claim Claim Information about what steps need to be taken to submit a claim for the service
1 insurance Insurance Allows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)
1 limits Limits Messages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general
1 network Network Providing information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)
1 appropriate-use Appropriate Use Guidance on whether appropriate-use documentation is needed
1 cost Cost What is the anticipated cost to the patient based on their coverage
1 therapy-alternatives-opt Optional Therapy Alternatives Are there alternative therapies that have better coverage and/or are lower-cost for the patient
1 therapy-alternatives-req Required Therapy Alternatives Are there alternative therapies that must be tried first prior to coverage being available for the proposed therapy
1 clinical-reminder Clinical Reminder Reminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)
1 duplicate-therapy Duplicate Therapy Notice that the proposed intervention has already recently occurred with a different provider when that information isn't already available in the provider system
1 contraindication Contraindication Notice that the proposed intervention may be contraindicated based on information the payer has in their record that the provider doesn't have in theirs
1 guideline Guideline Indication that there is a guideline available for the proposed therapy (with an option to view)
1 off-guideline Off Guideline Notice that the proposed therapy may be contrary to best-practice guidelines, typically with an option to view the relevant guideline