Da Vinci Health Record Exchange (HRex)
0.2.0 - STU R1 - 2nd ballot

Da Vinci Health Record Exchange (HRex), published by HL7 International - Clinical Interoperability Council. This is not an authorized publication; it is the continuous build for version 0.2.0). This version is based on the current content of https://github.com/HL7/davinci-ehrx/ and changes regularly. See the Directory of published versions

: HRex Member Match Operation - JSON Representation

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{
  "resourceType" : "OperationDefinition",
  "id" : "member-match",
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><h2>MemberMatch</h2><p>OPERATION: MemberMatch</p><p>The official URL for this operation definition is: </p><pre>http://hl7.org/fhir/us/davinci-hrex/OperationDefinition/member-match</pre><div><p>The <strong>$member-match</strong> operation allows one health plan to retrieve a unique identifier for a member from another health plan using a member's demographic and coverage information.  This identifier can then be used to perform subsequent queries and operations.</p>\n</div><p>URL: [base]/Patient/$member-match</p><p>Parameters</p><table class=\"grid\"><tr><td><b>Use</b></td><td><b>Name</b></td><td><b>Cardinality</b></td><td><b>Type</b></td><td><b>Binding</b></td><td><b>Documentation</b></td></tr><tr><td>IN</td><td>MemberPatient</td><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/resource.html\">Resource</a></td><td/><td><div><p>Parameter submitted by the new plan <strong>SHALL</strong> contain US Core Patient containing member demographics.</p>\n</div></td></tr><tr><td>IN</td><td>OldCoverage</td><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/resource.html\">Resource</a></td><td/><td><div><p>Parameter submitted by the new plan <strong>SHALL</strong> contain Coverage details of prior health plan coverage provided by the member, typically from their health plan coverage card.</p>\n</div></td></tr><tr><td>IN</td><td>NewCoverage</td><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/resource.html\">Resource</a></td><td/><td><div><p>Parameter submitted by the new plan <strong>SHALL</strong> contain Coverage details of new or prospective health plan coverage provided by the new health plan based upon the member's enrollment.</p>\n</div></td></tr><tr><td>OUT</td><td>MemberPatient</td><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/resource.html\">Resource</a></td><td/><td><div><p>Parameter returned by the old plan resource <strong>SHALL</strong> contain the MemberPatient resource received from new plan with the ADDITION of an identifier of type &quot;UMB&quot; representing the unique identifier identifying the member of the old health plan.</p>\n</div></td></tr><tr><td>OUT</td><td>NewCoverage</td><td>1..1</td><td><a href=\"http://hl7.org/fhir/R4/resource.html\">Resource</a></td><td/><td><div><p>Parameter returned by the old plan resource <strong>SHALL</strong> contain the NewCoverage record received from the new plan.</p>\n</div></td></tr></table></div>"
  },
  "url" : "http://hl7.org/fhir/us/davinci-hrex/OperationDefinition/member-match",
  "version" : "0.2.0",
  "name" : "MemberMatch",
  "title" : "HRex Member Match Operation",
  "status" : "draft",
  "kind" : "operation",
  "date" : "2020-09-11T05:25:14+00:00",
  "publisher" : "HL7 International - Clinical Interoperability Council",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/cic"
        }
      ]
    }
  ],
  "description" : "The **$member-match** operation allows one health plan to retrieve a unique identifier for a member from another health plan using a member's demographic and coverage information.  This identifier can then be used to perform subsequent queries and operations.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US"
        }
      ]
    }
  ],
  "code" : "member-match",
  "resource" : [
    "Patient"
  ],
  "system" : false,
  "type" : true,
  "instance" : false,
  "inputProfile" : "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-parameters-member-match-in",
  "outputProfile" : "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-parameters-member-match-out",
  "parameter" : [
    {
      "name" : "MemberPatient",
      "use" : "in",
      "min" : 1,
      "max" : "1",
      "documentation" : "Parameter submitted by the new plan **SHALL** contain US Core Patient containing member demographics.",
      "type" : "Resource",
      "referencedFrom" : [
        {
          "source" : "OldCoverage",
          "sourceId" : "beneficiary"
        },
        {
          "source" : "NewCoverage",
          "sourceId" : "beneficiary"
        }
      ]
    },
    {
      "name" : "OldCoverage",
      "use" : "in",
      "min" : 1,
      "max" : "1",
      "documentation" : "Parameter submitted by the new plan **SHALL** contain Coverage details of prior health plan coverage provided by the member, typically from their health plan coverage card.",
      "type" : "Resource"
    },
    {
      "name" : "NewCoverage",
      "use" : "in",
      "min" : 1,
      "max" : "1",
      "documentation" : "Parameter submitted by the new plan **SHALL** contain Coverage details of new or prospective health plan coverage provided by the new health plan based upon the member's enrollment.",
      "type" : "Resource"
    },
    {
      "name" : "MemberPatient",
      "use" : "out",
      "min" : 1,
      "max" : "1",
      "documentation" : "Parameter returned by the old plan resource **SHALL** contain the MemberPatient resource received from new plan with the ADDITION of an identifier of type \"UMB\" representing the unique identifier identifying the member of the old health plan.",
      "type" : "Resource",
      "referencedFrom" : [
        {
          "source" : "NewCoverage",
          "sourceId" : "beneficiary"
        }
      ]
    },
    {
      "name" : "NewCoverage",
      "use" : "out",
      "min" : 1,
      "max" : "1",
      "documentation" : "Parameter returned by the old plan resource **SHALL** contain the NewCoverage record received from the new plan.",
      "type" : "Resource"
    }
  ]
}