Da Vinci Payer Data Exchange
2.1.0 - STU2 United States of America flag

Da Vinci Payer Data Exchange, published by HL7 International / Financial Management. 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-epdx/ and changes regularly. See the Directory of published versions

PDex MedicationDispense

Previous Page - US Core Medication

The Da Vinci PDex MedicationDispense profile SHALL be used to record a member’s prescription drug claims.

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the Da Vinci PDex MedicationDispense profile are:

R4 Element Name Cardinality Type
MedicationDispense.status status 1..1 code
MedicationDispense.medication[x] medication[x] 1..1  
MedicationDispense.subject subject 1..1 Reference(US Core Patient )
MedicationDispense.performer.actor actor 1..1 Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson)
MedicationDispense.substitution.wasSubstituted wasSubstituted 1..1 boolean

Table Definition

Health Plan Mapping Assistance

A collaboration of Health Plan experts has performed an evaluation of claims information and developed a mapping of data for Members to the PDex MedicationDispense profile. This is shown below as an assistance to implementers:

PDex Element Must Support Cardinality CARIN-BB Element CPCDS Element Mapping or Implementer Note
- MedicationDispense.meta.lastUpdated   0..1 ExplanationOfBenefit.meta.lastUpdated [{“163”:”EOB Last Updated Date”}]
MedicationDispense.identifier   0..* ExplanationOfBenefit.Identifier [{“35”:”RX service reference number”}]. Note: Assign Payer System URI for Unique Claim Id in MedicationDispense.identifier.system. SetClaim Id in MedicationDispense.identifier.value
MedicationDispense.status S 1..1 ExplanationOfBenefit.status [{“140”:”Claim processing status code
”}] Note: Default to “completed”
MedicationDispense.medication[x]   1..1   . Note: Enter prescription information in sub-elements below
- MedicationDispense.medicationReference     ExplanationOfBenefit.supportingInfo.code, ExplanationOfBenefit.detail.productOrService [{“79”:”NCPDP field # 408-D8 (Dispensed As Written (DAW)/Product Selection Code) https://ushik.ahrq.gov/ViewItemDetails?itemKey=200387000&system=sdo”}, {“38, 78”:”National drug code
Compound Code”}]
MedicationDispense.subject S 1..1 ExplanationOfBenefit.patient [{“Ref (1), Ref (109)”:”Member id, Patient account number”}, {“Ref (191)”:”Unique Member ID”}, {“Ref (110)”:”Medical record number”}]
- MedicationDispense.performer.function   0..1 ExplanationOfBenefit.careTeam.role [{“165”:”Care Team Role (Value pcp|Prescribing)”}]
- MedicationDispense.performer.actor   1..1 ExplanationOfBenefit.careTeam.provider [{“Ref(96,122)”:”Provider NPIs”}, {“Ref(169,172)”:”Provider Names”}, {“94, 167”:”Claum billing provider NPI, Claim billing provider name”}]
MedicationDispense.quantity   0..1 ExplanationOfBenefit.item.quantity [{““39,151””:”Quantity dispensed | Quantity Qualifier Code”}]
MedicationDispense.daysSupply   0..1 ExplanationOfBenefit.supportingInfo.valueQuantity [{“77”:”Days supply”}]
MedicationDispense.whenHandedOver   0..1 ExplanationOfBenefit.item.servicedDate [{“90”:”Service (from) date”}]

Table Definition

Example MedicationDispense Resource

An example mapping of a MedicationDispense resource is shown here for a dispense for Over-The-Counter medication - Tylenol PM (NDC code) - on hold with as needed dosage with a condition, a dose Range and an Event History:

MedicationDispense Example

Next Page - US Core MedicationRequest