Da Vinci Payer Data Exchange
2.2.1 - STU 2.2 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 2.2.1 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

Resource Profile: Provider Member No Match Group ( Experimental )

Official URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provider-member-no-match Version: 2.2.1
Standards status: Informative Computable Name: ProviderMemberNoMatchGroup
Other Identifiers: OID:2.16.840.1.113883.4.642.40.8.42.47

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

A Group List created by the Payer to provide information back to a requesting provider about failed matches. Based on the Group resource. An Extension is added to capture the submitted patient demographics from the provider's request. The match may have failed for one of two reasons: a) No match on member (member not found in payer's system), or b) Matched but unable to comply due to member's opt-out of Provider Access API.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Group C 0..* Group Group of multiple entities
Constraints: grp-1
Group.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Group.contained 0..* Resource Submitted member demographics from provider
Group.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Group.identifier This element must be supported. This element is included in summaries. 0..* Identifier Provider organization identifier
Group.type This element is included in summaries. 1..1 code Group of persons (patients)
Binding: GroupType (required): Types of resources that are part of group.
Required Pattern: person (extensions allowed)
Group.actual This element is included in summaries. C 1..1 boolean Actual group (not definitional)
Required Pattern: true (extensions allowed)
Group.code This element must be supported. This element is included in summaries. 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
Group.managingEntity This element must be supported. This element is included in summaries. 1..1 Reference(Organization) Payer managing this group
Group.member This element must be supported. C 1..* BackboneElement Non-matched or consent-constrained members
Group.member.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Group.member.entity This element must be supported. 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
Group.member.entity.Slices for extension Content/Rules for all slices
Group.member.entity.Slices for extension.extension:nonMatchedMember This element must be supported. 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Group.type Base required GroupType 📍4.0.1 FHIR Std.
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.2.1 This IG

Constraints

Id Grade Path(s) Description Expression

This structure is derived from Group

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Group 0..* Group Group of multiple entities
Group.contained 0..* Resource Submitted member demographics from provider
Group.identifier This element must be supported. 0..* Identifier Provider organization identifier
Group.type 1..1 code Group of persons (patients)
Required Pattern: person (extensions allowed)
Group.code This element must be supported. 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
Group.managingEntity This element must be supported. 1..1 Reference(Organization) Payer managing this group
Group.member This element must be supported. 1..* BackboneElement Non-matched or consent-constrained members
Group.member.entity This element must be supported. 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
Group.member.entity.Slices for extension Content/Rules for all slices
Group.member.entity.Slices for extension.extension:nonMatchedMember This element must be supported. 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.2.1 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: doco
Group C 0..* Group Group of multiple entities
Constraints: grp-1
Group.id This element is included in summaries. 0..1 id Logical id of this artifact
Group.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Group.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Group.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Group.text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Group.contained 0..* Resource Submitted member demographics from provider
Group.extension 0..* Extension Additional content defined by implementations
Group.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Group.identifier This element must be supported. This element is included in summaries. 0..* Identifier Provider organization identifier
Group.active This element is included in summaries. 0..1 boolean Whether this group's record is in active use
Group.type This element is included in summaries. 1..1 code Group of persons (patients)
Binding: GroupType (required): Types of resources that are part of group.
Required Pattern: person (extensions allowed)
Group.actual This element is included in summaries. C 1..1 boolean Actual group (not definitional)
Required Pattern: true (extensions allowed)
Group.code This element must be supported. This element is included in summaries. 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
Group.name This element is included in summaries. 0..1 string Label for Group
Group.quantity This element is included in summaries. 0..1 unsignedInt Number of members
Group.managingEntity This element must be supported. This element is included in summaries. 1..1 Reference(Organization) Payer managing this group
Group.characteristic 0..* BackboneElement Include / Exclude group members by Trait
Group.characteristic.id 0..1 string Unique id for inter-element referencing
Group.characteristic.extension 0..* Extension Additional content defined by implementations
Group.characteristic.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Group.characteristic.code 1..1 CodeableConcept Kind of characteristic
Binding Description: (example): List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.
Group.characteristic.value[x] 1..1 Value held by characteristic
Binding Description: (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.
Group.characteristic.value[x].valueCodeableConcept CodeableConcept
Group.characteristic.value[x].valueBoolean boolean
Group.characteristic.value[x].valueQuantity Quantity
Group.characteristic.value[x].valueRange Range
Group.characteristic.value[x].valueReference Reference(Any)
Group.characteristic.exclude 1..1 boolean Group includes or excludes
Group.characteristic.period 0..1 Period Period over which characteristic is tested
Group.member This element must be supported. C 1..* BackboneElement Non-matched or consent-constrained members
Group.member.id 0..1 string Unique id for inter-element referencing
Group.member.extension 0..* Extension Additional content defined by implementations
Group.member.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Group.member.entity This element must be supported. 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
Group.member.entity.id 0..1 string Unique id for inter-element referencing
Group.member.entity.Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Group.member.entity.Slices for extension.extension:nonMatchedMember This element must be supported. 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters
Group.member.entity.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
Group.member.entity.type This element is included in summaries. 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
Group.member.entity.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known
Group.member.entity.display This element is included in summaries. 0..1 string Text alternative for the resource
Group.member.period 0..1 Period Period member belonged to the group
Group.member.inactive 0..1 boolean If member is no longer in group

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Group.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Group.type Base required GroupType 📍4.0.1 FHIR Std.
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.2.1 This IG
Group.characteristic.​code Base example Not State Unknown
Group.characteristic.​value[x] Base example Not State Unknown
Group.member.entity.​type Base extensible ResourceType 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

This structure is derived from Group

Summary

Mandatory: 3 elements
Must-Support: 6 elements

Extensions

This structure refers to these extensions:

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Group C 0..* Group Group of multiple entities
Constraints: grp-1
Group.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Group.contained 0..* Resource Submitted member demographics from provider
Group.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Group.identifier This element must be supported. This element is included in summaries. 0..* Identifier Provider organization identifier
Group.type This element is included in summaries. 1..1 code Group of persons (patients)
Binding: GroupType (required): Types of resources that are part of group.
Required Pattern: person (extensions allowed)
Group.actual This element is included in summaries. C 1..1 boolean Actual group (not definitional)
Required Pattern: true (extensions allowed)
Group.code This element must be supported. This element is included in summaries. 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
Group.managingEntity This element must be supported. This element is included in summaries. 1..1 Reference(Organization) Payer managing this group
Group.member This element must be supported. C 1..* BackboneElement Non-matched or consent-constrained members
Group.member.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Group.member.entity This element must be supported. 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
Group.member.entity.Slices for extension Content/Rules for all slices
Group.member.entity.Slices for extension.extension:nonMatchedMember This element must be supported. 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Group.type Base required GroupType 📍4.0.1 FHIR Std.
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.2.1 This IG

Constraints

Id Grade Path(s) Description Expression

Differential View

This structure is derived from Group

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Group 0..* Group Group of multiple entities
Group.contained 0..* Resource Submitted member demographics from provider
Group.identifier This element must be supported. 0..* Identifier Provider organization identifier
Group.type 1..1 code Group of persons (patients)
Required Pattern: person (extensions allowed)
Group.actual 1..1 boolean Actual group (not definitional)
Required Pattern: true (extensions allowed)
Group.code This element must be supported. 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
Group.managingEntity This element must be supported. 1..1 Reference(Organization) Payer managing this group
Group.member This element must be supported. 1..* BackboneElement Non-matched or consent-constrained members
Group.member.entity This element must be supported. 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
Group.member.entity.Slices for extension Content/Rules for all slices
Group.member.entity.Slices for extension.extension:nonMatchedMember This element must be supported. 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.2.1 This IG

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: doco
Group C 0..* Group Group of multiple entities
Constraints: grp-1
Group.id This element is included in summaries. 0..1 id Logical id of this artifact
Group.meta This element is included in summaries. 0..1 Meta Metadata about the resource
Group.implicitRules This element is a modifier element. This element is included in summaries. 0..1 uri A set of rules under which this content was created
Group.language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.
Additional BindingsPurpose
AllLanguages Max Binding
Group.text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Group.contained 0..* Resource Submitted member demographics from provider
Group.extension 0..* Extension Additional content defined by implementations
Group.modifierExtension This element is a modifier element. 0..* Extension Extensions that cannot be ignored
Group.identifier This element must be supported. This element is included in summaries. 0..* Identifier Provider organization identifier
Group.active This element is included in summaries. 0..1 boolean Whether this group's record is in active use
Group.type This element is included in summaries. 1..1 code Group of persons (patients)
Binding: GroupType (required): Types of resources that are part of group.
Required Pattern: person (extensions allowed)
Group.actual This element is included in summaries. C 1..1 boolean Actual group (not definitional)
Required Pattern: true (extensions allowed)
Group.code This element must be supported. This element is included in summaries. 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
Group.name This element is included in summaries. 0..1 string Label for Group
Group.quantity This element is included in summaries. 0..1 unsignedInt Number of members
Group.managingEntity This element must be supported. This element is included in summaries. 1..1 Reference(Organization) Payer managing this group
Group.characteristic 0..* BackboneElement Include / Exclude group members by Trait
Group.characteristic.id 0..1 string Unique id for inter-element referencing
Group.characteristic.extension 0..* Extension Additional content defined by implementations
Group.characteristic.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Group.characteristic.code 1..1 CodeableConcept Kind of characteristic
Binding Description: (example): List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.
Group.characteristic.value[x] 1..1 Value held by characteristic
Binding Description: (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.
Group.characteristic.value[x].valueCodeableConcept CodeableConcept
Group.characteristic.value[x].valueBoolean boolean
Group.characteristic.value[x].valueQuantity Quantity
Group.characteristic.value[x].valueRange Range
Group.characteristic.value[x].valueReference Reference(Any)
Group.characteristic.exclude 1..1 boolean Group includes or excludes
Group.characteristic.period 0..1 Period Period over which characteristic is tested
Group.member This element must be supported. C 1..* BackboneElement Non-matched or consent-constrained members
Group.member.id 0..1 string Unique id for inter-element referencing
Group.member.extension 0..* Extension Additional content defined by implementations
Group.member.modifierExtension This element is a modifier element. This element is included in summaries. 0..* Extension Extensions that cannot be ignored even if unrecognized
Group.member.entity This element must be supported. 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
Group.member.entity.id 0..1 string Unique id for inter-element referencing
Group.member.entity.Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
Group.member.entity.Slices for extension.extension:nonMatchedMember This element must be supported. 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters
Group.member.entity.reference This element is included in summaries. C 0..1 string Literal reference, Relative, internal or absolute URL
Group.member.entity.type This element is included in summaries. 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
Group.member.entity.identifier This element is included in summaries. 0..1 Identifier Logical reference, when literal reference is not known
Group.member.entity.display This element is included in summaries. 0..1 string Text alternative for the resource
Group.member.period 0..1 Period Period member belonged to the group
Group.member.inactive 0..1 boolean If member is no longer in group

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Group.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Group.type Base required GroupType 📍4.0.1 FHIR Std.
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.2.1 This IG
Group.characteristic.​code Base example Not State Unknown
Group.characteristic.​value[x] Base example Not State Unknown
Group.member.entity.​type Base extensible ResourceType 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression

This structure is derived from Group

Summary

Mandatory: 3 elements
Must-Support: 6 elements

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel, Schematron