Da Vinci Clinical Data Exchange (CDex), published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ecdx/ and changes regularly. See the Directory of published versions
| Page standards status: Trial-use | Maturity Level: 2 |
{
"resourceType" : "Requirements",
"id" : "cdex-payer",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Requirements cdex-payer</b></p><a name=\"cdex-payer\"> </a><a name=\"hccdex-payer\"> </a><table class=\"grid\"><tr><td><b><a name=\"CONF-012\"> </a></b>CONF-012</td><td>SHALL</td><td><div><p>This <code>Task.input</code> element represents the service date or the service's starting date for the claim or prior authorization. If the attachment is for a claim, it <strong>SHALL</strong> be present and precise to the day. It is optional if the attachment is for a prior authorization.</p>\n</div><p>Links: </p><ul><li>References: <a href=\"requesting-attachments-code.html#date-of-service-for-the-claim\">requesting-attachments-code.html</a></li></ul></td></tr><tr><td><b><a name=\"CONF-022\"> </a></b>CONF-022</td><td>SHALL</td><td><div><ol>\n<li>Servers <strong>SHALL</strong> document in their Capability Statement's <code>CapabilityStatement,operation.documentation</code> element or payer-supplied documentation:</li>\n</ol>\n</div><p>Links: </p><ul><li>References: <a href=\"sending-attachments.html#large-payloads\">sending-attachments.html</a></li></ul></td></tr><tr><td><b><a name=\"CONF-023\"> </a></b>CONF-023</td><td>SHALL</td><td><div><ol>\n<li>When the payload is too big, the Server <strong>SHALL</strong> use The HTTP <code>413 Content Too Large</code> client error response status code (alternate status messages "Request Entity Too Large" or "Payload Too Large").</li>\n</ol>\n</div><p>Links: </p><ul><li>References: <a href=\"sending-attachments.html#large-payloads\">sending-attachments.html</a></li></ul></td></tr><tr><td><b><a name=\"CONF-024\"> </a></b>CONF-024</td><td>SHALL</td><td><div><ol>\n<li>Servers <strong>SHALL</strong> document instructions for the Client when the payload is (or is anticipated to be) too big. (for example, send a URL + authorization information, offload to external storage, split multiple files into multiple operations)</li>\n</ol>\n</div><p>Links: </p><ul><li>References: <a href=\"sending-attachments.html#large-payloads\">sending-attachments.html</a></li></ul></td></tr><tr><td><b><a name=\"CONF-025\"> </a></b>CONF-025</td><td>SHALL</td><td><div><ul>\n<li>If the signatures fail verification when processing the [<code>$submit-attachment</code>] operation, the Data Source/Responder <strong>SHALL</strong> return an HTTP <code>400 Bad Request</code> <em>and</em> an OperationOutcome declaring that the signature was invalid.</li>\n</ul>\n</div><p>Links: </p><ul><li>References: <a href=\"sending-attachments.html#the-payer-requirements\">sending-attachments.html</a></li></ul></td></tr><tr><td><b><a name=\"CONF-079\"> </a></b>CONF-079</td><td>SHALL</td><td><div><ul>\n<li>A "ServiceDate" <code>Task.input</code> element representing the date of service or starting date of the service for the claim or prior authorization. It <strong>SHALL</strong> be present if the attachment is for a claim.</li>\n</ul>\n</div><p>Links: </p><ul><li>References: <a href=\"StructureDefinition-cdex-task-attachment-request.html\">StructureDefinition-cdex-task-attachment-request.html</a></li></ul></td></tr><tr><td><b><a name=\"CONF-098\"> </a></b>CONF-098</td><td>SHALL</td><td><div><p><strong>For CDex attachment requests transactions, the Payer SHALL use the [CDex Task Attachment Request Profile] to solicit information from a Provider.</strong></p>\n</div><p>Links: </p><ul><li>References: <a href=\"requesting-attachments-code.html#cdex-attachment-request-profile\">requesting-attachments-code.html</a></li></ul></td></tr><tr><td><b><a name=\"CONF-099\"> </a></b>CONF-099</td><td>SHALL</td><td><div><p><strong>For CDex attachment requests transactions, the Payer SHALL use the [CDex Task Attachment Request Profile] to solicit information from a Provider.</strong></p>\n</div><p>Links: </p><ul><li>References: <a href=\"requesting-attachments-questionnaire.html#cdex-attachment-request-profile\">requesting-attachments-questionnaire.html</a></li></ul></td></tr><tr><td><b><a name=\"CONF-003\"> </a></b>CONF-003</td><td>SHOULD</td><td><div><p>|Attachment.Content|{{OK}}(DocumentReference, QuestionnaireResponse if support Requesting Attachments Using Questionnaire|{{OK}}(Servers SHOULD support other FHIR types)|</p>\n</div><p>Links: </p><ul><li>References: <a href=\"attachments-conformance.html#submit-attachment-parameters-for-sending-attachments\">attachments-conformance.html</a></li></ul></td></tr><tr><td><b><a name=\"CONF-021\"> </a></b>CONF-021</td><td>SHOULD</td><td><div><ul>\n<li>The Payer <strong>SHOULD</strong> return an informational OperationOutcome with the HTTP accept response if the attachments can not be associated with a <em>current</em> claim or prior authorization and are being held for association with a <em>future</em> claim or prior authorization. An OperationOutcome example is used in Scenario 1b below.</li>\n</ul>\n</div><p>Links: </p><ul><li>References: <a href=\"sending-attachments.html#technical-workflow\">sending-attachments.html</a></li></ul></td></tr></table></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
"valueCode" : "claims"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger" : 2,
"_valueInteger" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical" : "http://hl7.org/fhir/us/davinci-cdex/ImplementationGuide/hl7.fhir.us.davinci-cdex"
}
]
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "trial-use",
"_valueCode" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
"valueCanonical" : "http://hl7.org/fhir/us/davinci-cdex/ImplementationGuide/hl7.fhir.us.davinci-cdex"
}
]
}
}
],
"url" : "http://hl7.org/fhir/us/davinci-cdex/Requirements/cdex-payer",
"identifier" : [
{
"system" : "urn:ietf:rfc:3986",
"value" : "urn:oid:2.16.840.1.113883.4.642.40.21.36.3"
}
],
"version" : "2.1.0",
"name" : "CDexPayerRequirements",
"title" : "CDex Payer Requirements",
"status" : "draft",
"date" : "2026-06-10T20:32:01+00:00",
"publisher" : "HL7 International / Payer/Provider Information Exchange Work Group",
"contact" : [
{
"name" : "HL7 International / Payer/Provider Information Exchange Work Group",
"telecom" : [
{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/claims"
},
{
"system" : "email",
"value" : "pie@lists.hl7.org"
}
]
}
],
"description" : "This [Requirements](https://hl7.org/fhir/R5/requirements.html) resource lists all the CDex Payer requirements defined in the narrative sections of this IG.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US"
}
]
}
],
"copyright" : "Used by permission of HL7 International all rights reserved Creative Commons License",
"statement" : [
{
"key" : "CONF-012",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "This `Task.input` element represents the service date or the service's starting date for the claim or prior authorization. If the attachment is for a claim, it **SHALL** be present and precise to the day. It is optional if the attachment is for a prior authorization.",
"reference" : [
"requesting-attachments-code.html#date-of-service-for-the-claim"
]
},
{
"key" : "CONF-022",
"conformance" : [
"SHALL"
],
"requirement" : "1. Servers **SHALL** document in their Capability Statement's `CapabilityStatement,operation.documentation` element or payer-supplied documentation:",
"reference" : [
"sending-attachments.html#large-payloads"
]
},
{
"key" : "CONF-023",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "1. When the payload is too big, the Server **SHALL** use The HTTP `413 Content Too Large` client error response status code (alternate status messages \"Request Entity Too Large\" or \"Payload Too Large\").",
"reference" : [
"sending-attachments.html#large-payloads"
]
},
{
"key" : "CONF-024",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "1. Servers **SHALL** document instructions for the Client when the payload is (or is anticipated to be) too big. (for example, send a URL + authorization information, offload to external storage, split multiple files into multiple operations)",
"reference" : [
"sending-attachments.html#large-payloads"
]
},
{
"key" : "CONF-025",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "- If the signatures fail verification when processing the [`$submit-attachment`] operation, the Data Source/Responder **SHALL** return an HTTP `400 Bad Request` *and* an OperationOutcome declaring that the signature was invalid.",
"reference" : [
"sending-attachments.html#the-payer-requirements"
]
},
{
"key" : "CONF-079",
"conformance" : [
"SHALL"
],
"conditionality" : true,
"requirement" : "- A \"ServiceDate\" `Task.input` element representing the date of service or starting date of the service for the claim or prior authorization. It **SHALL** be present if the attachment is for a claim.",
"reference" : [
"StructureDefinition-cdex-task-attachment-request.html"
]
},
{
"key" : "CONF-098",
"conformance" : [
"SHALL"
],
"requirement" : "**For CDex attachment requests transactions, the Payer SHALL use the [CDex Task Attachment Request Profile] to solicit information from a Provider.**",
"reference" : [
"requesting-attachments-code.html#cdex-attachment-request-profile"
]
},
{
"key" : "CONF-099",
"conformance" : [
"SHALL"
],
"requirement" : "**For CDex attachment requests transactions, the Payer SHALL use the [CDex Task Attachment Request Profile] to solicit information from a Provider.**",
"reference" : [
"requesting-attachments-questionnaire.html#cdex-attachment-request-profile"
]
},
{
"key" : "CONF-003",
"conformance" : [
"SHOULD"
],
"conditionality" : true,
"requirement" : "|Attachment.Content|{{OK}}(DocumentReference, QuestionnaireResponse if support Requesting Attachments Using Questionnaire|{{OK}}(Servers SHOULD support other FHIR types)|",
"reference" : [
"attachments-conformance.html#submit-attachment-parameters-for-sending-attachments"
]
},
{
"key" : "CONF-021",
"conformance" : [
"SHOULD"
],
"conditionality" : true,
"requirement" : "- The Payer **SHOULD** return an informational OperationOutcome with the HTTP accept response if the attachments can not be associated with a *current* claim or prior authorization and are being held for association with a *future* claim or prior authorization. An OperationOutcome example is used in Scenario 1b below.",
"reference" : [
"sending-attachments.html#technical-workflow"
]
}
]
}