Member-Provider Treatment Relationship Group - Da Vinci Payer Data Exchange v2.2.1

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: Member-Provider Treatment Relationship Group

Official URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-treatment-relationship		Version: 2.2.1
Standards status: Trial-use	Maturity Level: 2	Computable Name: MemberProviderTreatmentRelationship
Other Identifiers: OID:2.16.840.1.113883.4.642.40.8.42.48
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

A Group resource representing the treatment relationship between a specific member/patient and one or more healthcare providers. The Payer is the managing organization. The member is identified through a characteristic containing the Patient ID. The group members are the providers that have an active or confirmed treatment relationship with the member.

Usages:

This Profile is not used by any profiles in this Specification

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.

Key Elements Table
Differential Table
Snapshot Table
Statistics/References
All

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
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.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	Unique identifier for the treatment relationship group
Group.active	This element must be supported. This element is included in summaries.	0..1	boolean	Treatment relationship group is active Required Pattern: true (extensions allowed)
Group.type	This element must be supported. This element is included in summaries.	1..1	code	Type of group (practitioners with treatment relationship) Binding: GroupType (required): Types of resources that are part of group. Required Pattern: practitioner (extensions allowed)
Group.actual	This element must be supported. This element is included in summaries. C	1..1	boolean	This is an actual collection of providers Required Pattern: true (extensions allowed)
Group.code	This element must be supported. This element is included in summaries.	0..1	CodeableConcept	Kind of treatment relationship Binding: PDex Multi-Member Match Result Value Set (required)
Group.quantity	This element must be supported. This element is included in summaries.	0..1	unsignedInt	Number of providers in the group
Group.managingEntity	This element must be supported. This element is included in summaries.	0..1	Reference(Organization)	The Payer managing this treatment relationship
Group.characteristic	This element must be supported.	0..*	BackboneElement	Member/Patient identifier and other characteristics
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	This element must be supported.	1..1	CodeableConcept	Identifies the member characteristic Binding Description: (example): List of characteristics used to describe group members; e.g. gender, age, owner, location, etc. Required Pattern: `{ "coding" : [ { "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PdexMemberAttributionCS", "code" : "pdex-member", "display" : "PDex Member" } ] }`
Group.characteristic.Slices for value[x]	This element must be supported.	1..1		Value held by characteristic Slice: Unordered, Closed by type:$this Binding Description: (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Group.characteristic.Slices for value[x].valueCodeableConcept			CodeableConcept
Group.characteristic.Slices for value[x].valueBoolean			boolean
Group.characteristic.Slices for value[x].valueQuantity			Quantity
Group.characteristic.Slices for value[x].valueRange			Range
Group.characteristic.Slices for value[x].valueReference			Reference(Any)
Group.characteristic.Slices for value[x].value[x]:valueReference	This element must be supported.	0..1	Reference(Patient)	Reference to the member/patient
Group.characteristic.exclude		1..1	boolean	This is an include, not an exclude Required Pattern: false (extensions allowed)
Group.characteristic.period	This element must be supported.	0..1	Period	Period during which this group is valid
Group.member	This element must be supported. C	0..*	BackboneElement	Providers with treatment relationship to the member
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(Practitioner \| PractitionerRole)	Provider entity
Group.member.entity.Slices for extension				Content/Rules for all slices
Group.member.entity.Slices for extension.extension:treatmentDetails		0..1	string	Details of the treatment relationship URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/treatment-relationship-details
Group.member.inactive		0..1	boolean	Whether the treatment relationship is currently active
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
Group.characteristic.code	Base	example		Not State	Unknown
Group.characteristic.value[x]	Base	example		Not State	Unknown
Group.characteristic.value[x]:valueCodeableConcept	Base	example		Not State	Unknown
Group.characteristic.value[x]:valueQuantity	Base	example		Not State	Unknown
Group.characteristic.value[x]:valueRange	Base	example		Not State	Unknown

Constraints

Grade

Path(s)

Description

Expression

This structure is derived from Group

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Group		0..*	Group	Group of multiple entities
Group.identifier	This element must be supported.	0..*	Identifier	Unique identifier for the treatment relationship group
Group.active	This element must be supported.	0..1	boolean	Treatment relationship group is active Required Pattern: true (extensions allowed)
Group.type	This element must be supported.	1..1	code	Type of group (practitioners with treatment relationship) Required Pattern: practitioner (extensions allowed)
Group.actual	This element must be supported.	1..1	boolean	This is an actual collection of providers Required Pattern: true (extensions allowed)
Group.code	This element must be supported.	0..1	CodeableConcept	Kind of treatment relationship Binding: PDex Multi-Member Match Result Value Set (required)
Group.quantity	This element must be supported.	0..1	unsignedInt	Number of providers in the group
Group.managingEntity	This element must be supported.	0..1	Reference(Organization)	The Payer managing this treatment relationship
Group.characteristic	This element must be supported.	0..*	BackboneElement	Member/Patient identifier and other characteristics
Group.characteristic.code	This element must be supported.	1..1	CodeableConcept	Identifies the member characteristic Required Pattern: `{ "coding" : [ { "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PdexMemberAttributionCS", "code" : "pdex-member", "display" : "PDex Member" } ] }`
Group.characteristic.Slices for value[x]	This element must be supported.	1..1	CodeableConcept, boolean, Quantity, Range, Reference()	Value held by characteristic Slice: Unordered, Open by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Group.characteristic.Slices for value[x].value[x]:valueReference	This element must be supported.	0..1	Reference(Patient)	Reference to the member/patient
Group.characteristic.exclude		1..1	boolean	This is an include, not an exclude Required Pattern: false (extensions allowed)
Group.characteristic.period	This element must be supported.	0..1	Period	Period during which this group is valid
Group.member	This element must be supported.	0..*	BackboneElement	Providers with treatment relationship to the member
Group.member.entity	This element must be supported.	1..1	Reference(Practitioner \| PractitionerRole)	Provider entity
Group.member.entity.Slices for extension				Content/Rules for all slices
Group.member.entity.Slices for extension.extension:treatmentDetails		0..1	string	Details of the treatment relationship URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/treatment-relationship-details
Group.member.inactive		0..1	boolean	Whether the treatment relationship is currently active
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

Description & Constraints Filter:

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

language

0..1

code

Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional Bindings

Purpose

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 Contained, inline Resources

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 Unique identifier for the treatment relationship group

Group.active This element must be supported. This element is included in summaries. 0..1 boolean Treatment relationship group is active
Required Pattern: true (extensions allowed)

Group.type This element must be supported. This element is included in summaries. 1..1 code Type of group (practitioners with treatment relationship)
Binding: GroupType (required): Types of resources that are part of group.
Required Pattern: practitioner (extensions allowed)

Group.actual This element must be supported. This element is included in summaries. C 1..1 boolean This is an actual collection of providers
Required Pattern: true (extensions allowed)

Group.code This element must be supported. This element is included in summaries. 0..1 CodeableConcept Kind of treatment relationship
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 must be supported. This element is included in summaries. 0..1 unsignedInt Number of providers in the group

Group.managingEntity This element must be supported. This element is included in summaries. 0..1 Reference(Organization) The Payer managing this treatment relationship

Group.characteristic This element must be supported. 0..* BackboneElement Member/Patient identifier and other characteristics

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

code

1..1

CodeableConcept

Identifies the member characteristic
Binding Description: (example): List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.
Required Pattern:

{
  "coding" : [
    {
      "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PdexMemberAttributionCS",
      "code" : "pdex-member",
      "display" : "PDex Member"
    }
  ]
}

Group.characteristic.Slices for value[x] This element must be supported. 1..1 Value held by characteristic
Slice: Unordered, Closed by type:$this
Binding Description: (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.
Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view

Group.characteristic.Slices for value[x].valueCodeableConcept CodeableConcept

Group.characteristic.Slices for value[x].valueBoolean boolean

Group.characteristic.Slices for value[x].valueQuantity Quantity

Group.characteristic.Slices for value[x].valueRange Range

Group.characteristic.Slices for value[x].valueReference Reference(Any)

Group.characteristic.Slices for value[x].value[x]:valueReference This element must be supported. 0..1 Reference(Patient) Reference to the member/patient

Group.characteristic.exclude 1..1 boolean This is an include, not an exclude
Required Pattern: false (extensions allowed)

Group.characteristic.period This element must be supported. 0..1 Period Period during which this group is valid

Group.member This element must be supported. C 0..* BackboneElement Providers with treatment relationship to the member

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(Practitioner | PractitionerRole) Provider entity

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:treatmentDetails 0..1 string Details of the treatment relationship
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/treatment-relationship-details

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 Whether the treatment relationship is currently active

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.characteristic.value[x]:valueCodeableConcept	Base	example		Not State	Unknown
Group.characteristic.value[x]:valueQuantity	Base	example		Not State	Unknown
Group.characteristic.value[x]:valueRange	Base	example		Not State	Unknown
Group.member.entity.type	Base	extensible	ResourceType	📍4.0.1	FHIR Std.

Constraints

Grade

Path(s)

Description

Expression

This structure is derived from Group

Summary

Must-Support: 14 elements

Extensions

This structure refers to these extensions:

http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/treatment-relationship-details

Slices

This structure defines the following Slices:

The element 1 is sliced based on the value of Group.characteristic.value[x]

Maturity: 2

Key Elements View

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
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.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	Unique identifier for the treatment relationship group
Group.active	This element must be supported. This element is included in summaries.	0..1	boolean	Treatment relationship group is active Required Pattern: true (extensions allowed)
Group.type	This element must be supported. This element is included in summaries.	1..1	code	Type of group (practitioners with treatment relationship) Binding: GroupType (required): Types of resources that are part of group. Required Pattern: practitioner (extensions allowed)
Group.actual	This element must be supported. This element is included in summaries. C	1..1	boolean	This is an actual collection of providers Required Pattern: true (extensions allowed)
Group.code	This element must be supported. This element is included in summaries.	0..1	CodeableConcept	Kind of treatment relationship Binding: PDex Multi-Member Match Result Value Set (required)
Group.quantity	This element must be supported. This element is included in summaries.	0..1	unsignedInt	Number of providers in the group
Group.managingEntity	This element must be supported. This element is included in summaries.	0..1	Reference(Organization)	The Payer managing this treatment relationship
Group.characteristic	This element must be supported.	0..*	BackboneElement	Member/Patient identifier and other characteristics
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	This element must be supported.	1..1	CodeableConcept	Identifies the member characteristic Binding Description: (example): List of characteristics used to describe group members; e.g. gender, age, owner, location, etc. Required Pattern: `{ "coding" : [ { "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PdexMemberAttributionCS", "code" : "pdex-member", "display" : "PDex Member" } ] }`
Group.characteristic.Slices for value[x]	This element must be supported.	1..1		Value held by characteristic Slice: Unordered, Closed by type:$this Binding Description: (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc. Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Group.characteristic.Slices for value[x].valueCodeableConcept			CodeableConcept
Group.characteristic.Slices for value[x].valueBoolean			boolean
Group.characteristic.Slices for value[x].valueQuantity			Quantity
Group.characteristic.Slices for value[x].valueRange			Range
Group.characteristic.Slices for value[x].valueReference			Reference(Any)
Group.characteristic.Slices for value[x].value[x]:valueReference	This element must be supported.	0..1	Reference(Patient)	Reference to the member/patient
Group.characteristic.exclude		1..1	boolean	This is an include, not an exclude Required Pattern: false (extensions allowed)
Group.characteristic.period	This element must be supported.	0..1	Period	Period during which this group is valid
Group.member	This element must be supported. C	0..*	BackboneElement	Providers with treatment relationship to the member
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(Practitioner \| PractitionerRole)	Provider entity
Group.member.entity.Slices for extension				Content/Rules for all slices
Group.member.entity.Slices for extension.extension:treatmentDetails		0..1	string	Details of the treatment relationship URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/treatment-relationship-details
Group.member.inactive		0..1	boolean	Whether the treatment relationship is currently active
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
Group.characteristic.code	Base	example		Not State	Unknown
Group.characteristic.value[x]	Base	example		Not State	Unknown
Group.characteristic.value[x]:valueCodeableConcept	Base	example		Not State	Unknown
Group.characteristic.value[x]:valueQuantity	Base	example		Not State	Unknown
Group.characteristic.value[x]:valueRange	Base	example		Not State	Unknown

Constraints

Grade

Path(s)

Description

Expression

Differential View

This structure is derived from Group

Name	Flags	Card.	Type	Description & Constraints Filter: Bindings Constraints Obligations
Group		0..*	Group	Group of multiple entities
Group.identifier	This element must be supported.	0..*	Identifier	Unique identifier for the treatment relationship group
Group.active	This element must be supported.	0..1	boolean	Treatment relationship group is active Required Pattern: true (extensions allowed)
Group.type	This element must be supported.	1..1	code	Type of group (practitioners with treatment relationship) Required Pattern: practitioner (extensions allowed)
Group.actual	This element must be supported.	1..1	boolean	This is an actual collection of providers Required Pattern: true (extensions allowed)
Group.code	This element must be supported.	0..1	CodeableConcept	Kind of treatment relationship Binding: PDex Multi-Member Match Result Value Set (required)
Group.quantity	This element must be supported.	0..1	unsignedInt	Number of providers in the group
Group.managingEntity	This element must be supported.	0..1	Reference(Organization)	The Payer managing this treatment relationship
Group.characteristic	This element must be supported.	0..*	BackboneElement	Member/Patient identifier and other characteristics
Group.characteristic.code	This element must be supported.	1..1	CodeableConcept	Identifies the member characteristic Required Pattern: `{ "coding" : [ { "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PdexMemberAttributionCS", "code" : "pdex-member", "display" : "PDex Member" } ] }`
Group.characteristic.Slices for value[x]	This element must be supported.	1..1	CodeableConcept, boolean, Quantity, Range, Reference()	Value held by characteristic Slice: Unordered, Open by type:$this Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them Other type slices that contain no new information are not shown in this view
Group.characteristic.Slices for value[x].value[x]:valueReference	This element must be supported.	0..1	Reference(Patient)	Reference to the member/patient
Group.characteristic.exclude		1..1	boolean	This is an include, not an exclude Required Pattern: false (extensions allowed)
Group.characteristic.period	This element must be supported.	0..1	Period	Period during which this group is valid
Group.member	This element must be supported.	0..*	BackboneElement	Providers with treatment relationship to the member
Group.member.entity	This element must be supported.	1..1	Reference(Practitioner \| PractitionerRole)	Provider entity
Group.member.entity.Slices for extension				Content/Rules for all slices
Group.member.entity.Slices for extension.extension:treatmentDetails		0..1	string	Details of the treatment relationship URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/treatment-relationship-details
Group.member.inactive		0..1	boolean	Whether the treatment relationship is currently active
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