HL7 Terminology (THO)
7.1.0 - Publication
HL7 Terminology (THO)
7.1.0 - Publication
This page is part of the HL7 Terminology (v7.1.0: Release) based on FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions
| Official URL: http://terminology.hl7.org/ValueSet/medical-management-type | Version: 1.0.0 | ||||
| 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 |
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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)
Last updated: 2025-05-26 00:00:00+0000; Language: en
Profile: Shareable ValueSet
http://terminology.hl7.org/CodeSystem/medical-management-type version 📦1.0.0
Expansion performed internally based on codesystem Medical Management Type v1.0.0 (CodeSystem)
This value set contains 3 concepts
| System | Code | Display (en) | Definition | JSON | XML |
http://terminology.hl7.org/CodeSystem/medical-management-type | concurrent-review | Concurrent Review | Review of medical necessity while the patient is actively receiving treatment. | ||
http://terminology.hl7.org/CodeSystem/medical-management-type | prior-auth | Prior Authorization | Review of medical necessity prior to receiving treatment. | ||
http://terminology.hl7.org/CodeSystem/medical-management-type | 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'. |
Description of the above table(s).
History
| Date | Action | Author | Custodian | Comment |
| 2025-07-05 | create | Corey Spears | FM | Create CodeSystem and ValueSet to indicate Medical Management Types; up-689 |
IG © 2020+ HL7 International - Vocabulary Work Group.
Package hl7.terminology#7.1.0 based on FHIR 5.0.0.
Generated
2026-03-08
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