Da Vinci Payer Data Exchange
2.1.1 - STU 2.1 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 2.1.1 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

Table of Contents

Page standards status: Informative
.. 0 Table of Contents
... 1 Home
... 2 Overview
... 3 Introduction
... 4 Narrative Conformance
... 5 PDex Implementation Guide
... 6 Security and Privacy
.... 6.1 FHIR Access Permissions
... 7 PDex Implementation, Actors, Interactions, Data Payloads and Methods
.... 7.1 Handling Data Provenance
.... 7.2 Provider Access API
.... 7.3 Provider Access API(v2)
.... 7.4 Payer-to-Payer Exchange (single member)
.... 7.5 Payer-to-Payer Exchange (bulk)
.... 7.6 Data Mapping
..... 7.6.1 US Core AllergyIntolerance
..... 7.6.2 US Core CarePlan
..... 7.6.3 US Core CareTeam
..... 7.6.4 US Core Condition
..... 7.6.5 Consent
..... 7.6.6 Coverage
..... 7.6.7 PDex Device
..... 7.6.8 US Core DiagnosticReport for Laboratory Results Reporting
..... 7.6.9 US Core DiagnosticReport for Report and Note Exchange
..... 7.6.10 US Core DocumentReference
..... 7.6.11 US Core Encounter
..... 7.6.12 US Core Goal
..... 7.6.13 US Core Immunization
..... 7.6.14 US Core ImplantableDevice
..... 7.6.15 US Core Laboratory Result Observation
..... 7.6.16 US Core Location
..... 7.6.17 US Core Medication
..... 7.6.18 PDex MedicationDispense
..... 7.6.19 US Core MedicationRequest
..... 7.6.20 US Core Organization
..... 7.6.21 US Core Patient
..... 7.6.22 US Core Pediatric BMI for Age Observation
..... 7.6.23 US Core Pediatric Head Occipital-frontal Circumference Observation
..... 7.6.24 US Core Pediatric Weight for Height Observation
..... 7.6.25 US Core Practitioner
..... 7.6.26 US Core PractitionerRole
..... 7.6.27 PDex Prior Authorization
..... 7.6.28 US Core Procedure
..... 7.6.29 PDex Provenance
..... 7.6.30 US Core Provenance
..... 7.6.31 US Core Pulse Oximetry
..... 7.6.32 US Core Smoking Status Observation
..... 7.6.33 VitalSigns
... 8 Use Case Scenarios
... 9 CDS Hooks
.... 9.1 Workflow Examples
... 10 Member-Authorized OAuth2.0 Exchange
... 11 Change History
... 12 Credits
... 13 Downloads
... 14 FHIR Artifacts
.... 14.1 PDex Payer-Access Server CapabilityStatement
.... 14.2 PDex provider-access Server CapabilityStatement
.... 14.3 PDEX Server CapabilityStatement
.... 14.4 PDex Server CapabilityStatement with US core 6.1 support
.... 14.5 Bulk Member Match Data Export
.... 14.6 PDex Bulk Member Match Operation
.... 14.7 PDex Provider-Member-Match Operation
.... 14.8 ExplanationOfBenefit_Identifier
.... 14.9 ExplanationOfBenefit_Patient
.... 14.10 ExplanationOfBenefit_ServiceDate
.... 14.11 ExplanationOfBenefit_Type
.... 14.12 ExplanationOfBenefit_Use
.... 14.13 Group_Code
.... 14.14 PDex Consent Action Search Parameter
.... 14.15 PDex Consent Provider Access Use Case Search Parameter
.... 14.16 PDex Consent Provision Type Search Parameter
.... 14.17 PdexMedicationDispensePatient
.... 14.18 PdexMedicationDispenseStatus
.... 14.19 Member Opt-Out Group
.... 14.20 Member-Provider Treatment Relationship Group
.... 14.21 mTLS Endpoint
.... 14.22 mTLS Endpoint Bundle
.... 14.23 mTLS Organization
.... 14.24 PDex $multi-member-match request
.... 14.25 PDex $multi-member-match response
.... 14.26 PDex Device
.... 14.27 PDex MedicationDispense
.... 14.28 PDex Member Match Group
.... 14.29 PDex Member No Match Group
.... 14.30 PDex Prior Authorization
.... 14.31 PDex Provenance
.... 14.32 PDex Provider Access Consent Profile
.... 14.33 PDex Provider Group
.... 14.34 Provider $multi-member-match Request
.... 14.35 Provider $multi-member-match Response
.... 14.36 Provider Attestation to Treatment Relationship
.... 14.37 Provider Member Match Group
.... 14.38 Provider Member No Match Group
.... 14.39 An attribute to describe the data source a resource was constructed from
.... 14.40 An attribute to express the amount of a service or item that has been utilized
.... 14.41 An attribute to express the refill number of a prescription
.... 14.42 LevelOfServiceCode
.... 14.43 Member Last Resource Filters
.... 14.44 Member Last Resource Types
.... 14.45 Member Last Transmission
.... 14.46 Member-Match Input Patient Parameter
.... 14.47 Members Opted-out
.... 14.48 mTLS Signed Object
.... 14.49 NDH Associated Servers
.... 14.50 NDH Contactpoint Availabletime
.... 14.51 NDH Dynamic Registration
.... 14.52 NDH Endpoint Access Control Mechanism
.... 14.53 NDH Endpoint Rank
.... 14.54 NDH Endpoint Usecase
.... 14.55 NDH FHIR IG
.... 14.56 NDH Identifier Status
.... 14.57 NDH Secure Exchange Artifacts
.... 14.58 NDH Trust Framework
.... 14.59 NDH Verification Status
.... 14.60 Opt-Out Details
.... 14.61 Opt-Out Reason
.... 14.62 Provider Access Use Case
.... 14.63 ReviewAction
.... 14.64 ReviewActionCode
.... 14.65 Treatment Relationship Details
.... 14.66 When Adjudicated
.... 14.67 Endpoint Payload Type Value Set
.... 14.68 FDA National Drug Code (NDC)
.... 14.69 mTLS Signed Object Types
.... 14.70 Opt-Out Reason
.... 14.71 Opt-Out Scope
.... 14.72 Organization Type VS
.... 14.73 Payer source of data
.... 14.74 PDex Adjudication
.... 14.75 PDex Adjudication Category Discriminator
.... 14.76 PDex Multi-Member Match Result Value Set
.... 14.77 PDex Payer Benefit Payment Status
.... 14.78 PDex SupportingInfo Type
.... 14.79 Prior Authorization Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS
.... 14.80 Prior Authorization Service Type Codes (X12)
.... 14.81 Prior Authorization value categories
.... 14.82 Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS
.... 14.83 Provenance Agent Type
.... 14.84 Treatment Attestation Provision Type
.... 14.85 Treatment Attestation Status
.... 14.86 Treatment Relationship Type
.... 14.87 Trust Framework Type Value Set
.... 14.88 X12 278 Review Decision Reason Codes
.... 14.89 X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes
.... 14.90 Endpoint Payload Types Code System
.... 14.91 mTLS Object Type Code
.... 14.92 Opt-Out Reason
.... 14.93 Opt-Out Scope
.... 14.94 Organization Type
.... 14.95 PDex Adjudication Discriminator
.... 14.96 PDex Identifier Type
.... 14.97 PDex Member Characteristic Code
.... 14.98 PDex Multi-Member Match Result Code System
.... 14.99 PDex Payer Adjudication Status
.... 14.100 PDex Provider Access API Attribution Code System
.... 14.101 PDex Supporting Info Type
.... 14.102 Prior Authorization Values
.... 14.103 Provenance Payer Data Source Format
.... 14.104 Provenance Roles
.... 14.105 Treatment Relationship Type
.... 14.106 Trust FrameworkType Code System
.... 14.107 Trust Profile Code System
.... 14.108 $multi-member-match payer example request
.... 14.109 $multi-member-match payer example response
.... 14.110 Acme
.... 14.111 BundleConditionWithProvenance
.... 14.112 BundleExamplePayer1
.... 14.113 BundleExamplePayer2
.... 14.114 BundleExamplePayer3
.... 14.115 BundleWithProvenance
.... 14.116 consentin2
.... 14.117 Coverage to Link Example 1
.... 14.118 Coverage to Match Example 1
.... 14.119 Coverage to Match Example 2
.... 14.120 coveragein2
.... 14.121 coveragelink2
.... 14.122 diamond-mtls-endpoint1
.... 14.123 diamond-mtls-endpoint2
.... 14.124 example-mtls-endpoint-bundle
.... 14.125 example-pdex-member-consent-constraint-group
.... 14.126 example-pdex-member-match-group
.... 14.127 example-pdex-member-no-match-group
.... 14.128 Example-PDex-Provider-Group
.... 14.129 ExampleBundle1
.... 14.130 ExampleCoverage
.... 14.131 ExampleDevice
.... 14.132 ExampleDocRefProvenance
.... 14.133 ExampleDocumentReference
.... 14.134 ExampleEncounter1
.... 14.135 ExampleEncounter2
.... 14.136 ExampleEncounter3
.... 14.137 ExampleLocation
.... 14.138 ExampleMedicationDispenseClaim
.... 14.139 ExamplePractitioner
.... 14.140 ExampleProvenanceAuthorEncounter6
.... 14.141 ExampleProvenanceAuthorEncounter7
.... 14.142 ExampleProvenanceBundleTransmitter
.... 14.143 ExampleProvenanceCustodian
.... 14.144 ExampleProvenancePayerModified
.... 14.145 ExampleProvenancePayerSource
.... 14.146 ExampleProvenanceSoloPractitioner
.... 14.147 ExampleProvenanceTransmitter
.... 14.148 mtlsorganization2
.... 14.149 Organization Provider Example 1
.... 14.150 Organization Provider Example 2
.... 14.151 OrganizationPayer1
.... 14.152 OrganizationPayer1-1
.... 14.153 OrganizationPayer2
.... 14.154 OrganizationPayer2-2
.... 14.155 OrganizationProvider1
.... 14.156 OrganizationProvider2
.... 14.157 Patient for Member Match Example 1
.... 14.158 Patient for Member Match Example 2
.... 14.159 Patient Provider Example 1 - Robert Johnson
.... 14.160 Patient Provider Example 2 - Sarah Williams
.... 14.161 Patient1
.... 14.162 Patient1-2
.... 14.163 Patient100
.... 14.164 Patient1001
.... 14.165 Patient2002
.... 14.166 patientin2
.... 14.167 Payer Member Example 1 - Robert Johnson
.... 14.168 Payer Member Example 2 - Sarah Williams
.... 14.169 Payer's Patient Record for Member 1001
.... 14.170 Payer's Patient Record for Member 2002
.... 14.171 PDex Provider Access Consent Opt-Out Example
.... 14.172 PDex Provider Access Consent Permit Example
.... 14.173 PDexCoverageExample
.... 14.174 PdexPriorAuth
.... 14.175 Practitioner Provider Example 1 - Dr. Smith
.... 14.176 Practitioner Provider Example 2 - Dr. Jones
.... 14.177 Provider Attestation Document Reference
.... 14.178 Provider Bulk Member Match Request Example
.... 14.179 Provider Bulk Member Match Response Example
.... 14.180 Provider Treatment Attestation Consent Example for Bulk Member Match
.... 14.181 Provider-Member-Match Request Example
.... 14.182 Provider-Member-Match Response Example
.... 14.183 Treatment Attestation Example 1
.... 14.184 Treatment Attestation Example 2
.... 14.185 Treatment Attestation Form Example 1
.... 14.186 Treatment Attestation Form Example 2
... 15 Other IG Artifacts