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TX: CodeSystem medical-management-type

Properties

Profile http://hl7.org/fhir/StructureDefinition/shareablecodesystem
Language en
Defining URL http://terminology.hl7.org/CodeSystem/medical-management-type
Version 1.0.0
Name MedicalManagementType
Title Medical Management Type
Status active
Definition

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.
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
Value Set Medical Management Type

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'.