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
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A downloadable version of this IG is available so it can be hosted locally:
Examples
All the examples that are used in this Implementation Guide available for download:
Definitions
IG/package dependencies
The following dependencies are used in production of this guide:
Globals table
There are no Global profiles defined
Cross version analysis
This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (hl7.fhir.us.davinci-pdex.r4) and R4B (hl7.fhir.us.davinci-pdex.r4b) are available.
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- ISO Maintains the copyright on the country codes, and controls it's use carefully. For futher details see the ISO 3166 web page: https://www.iso.org/iso-3166-country-codes.html
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- ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: AssociatedServers, BulkMemberMatch... Show 78 more, ContactPointAvailableTime, DaVinciPayerDataExchange, DispenseRefill, DynamicRegistration, EndpointAccessControlMechanism, EndpointConnectionTypeVersion, EndpointRank, EndpointUsecase, ExplanationOfBenefit_Identifier, ExplanationOfBenefit_Patient, ExplanationOfBenefit_ServiceDate, ExplanationOfBenefit_Type, ExplanationOfBenefit_Use, FDANationalDrugCode, FhirIg, Group_Code, IdentifierStatus, IdentifierTypeCS, LastFilters, LastTransmission, LastTypes, LevelOfServiceCode, MatchParameters, MembersOptedOut, MtlsBundle, MtlsEndpoint, MtlsObjectCodeCS, MtlsObjectTypeVS, MtlsOrganization, MtlsSignedObject, OrgTypeCS, OrgTypeVS, PDexAdjudication, PDexAdjudicationCS, PDexAdjudicationCategoryDiscriminator, PDexAdjudicationDiscriminator, PDexIdentifierType, PDexMemberMatchGroup, PDexMemberNoMatchGroup, PDexMultiMemberMatchRequestParameters, PDexMultiMemberMatchResponseParameters, PDexMultiMemberMatchResultVS, PDexPAInstitutionalProcedureCodes, PDexPAInstitutionalProcedureCodesVS, PDexPayerAdjudicationStatus, PDexPayerBenefitPaymentStatus, PDexProviderGroup, PDexProviderSharingConsent, PDexServerCapabilityStatement61, PDexSupportingInfoType, PdexDevice, PdexMedicationDispense, PdexMedicationDispensePatient, PdexMedicationDispenseStatus, PdexMemberAttributionCS, PdexMultiMemberMatchResultCS, PdexPayerAccessServerCapabilityStatement, PdexPriorAuthorization, PdexProviderAccessServerCapabilityStatement, PdexServerCapabilityStatement, PriorAuthServiceTypeCodes, PriorAuthorizationAmounts, PriorAuthorizationUtilization, PriorAuthorizationValueCodes, Provenance, ProvenanceAgentRoleType, ProvenanceAgentType, ProvenancePayerDataSource, ProvenancePayerSourceFormat, ProvenanceSourceFrom, ReviewAction, ReviewActionCode, SecureExchangeArtifacts, TrustFramework, VerificationStatus, WhenAdjudicated, X12278ReviewDecisionReasonCode and X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes
- These codes are excerpted from ASTM Standard, E1762-95(2013) - Standard Guide for Electronic Authentication of Health Care Information, Copyright by ASTM International, 100 Barr Harbor Drive, West Conshohocken, PA 19428. Copies of this standard are available through the ASTM Web Site at www.astm.org.
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- This CodeSystem is not copyrighted.
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- This is an example set based on ASTM Standard, E1762-95 (2013) HL7 RoleClass OID 2.16.840.1.113883.5.110, HL7 Role Code 2.16.840.1.113883.5.111, HL7 ParticipationType OID: 2.16.840.1.113883.5.90, HL7 ParticipationFunction codes at OID: 2.16.840.1.113883.5.88, and HL7 Security and Privacy Domain Analysis Model roles classes.
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- This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
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- This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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- Adjudication Value Codes: ExplanationOfBenefit/PDexPriorAuth1, PDexAdjudication and PdexPriorAuthorization
- Claim Type Codes: ExplanationOfBenefit/PDexPriorAuth1
- Condition Category Codes: Bundle/3000003
- Condition Clinical Status Codes: Bundle/3000003
- ConditionVerificationStatus: Bundle/3000003
- Consent Action Codes: Consent/no-consent-1, PDexProviderSharingConsent and Parameters/payer-multi-member-match-in
- Consent PolicyRule Codes: Consent/no-consent-1 and PDexProviderSharingConsent
- Consent Scope Codes: Consent/no-consent-1, PDexProviderSharingConsent and Parameters/payer-multi-member-match-in
- Coverage Class Codes: Parameters/payer-multi-member-match-in
- DataAbsentReason: PDexPAInstitutionalProcedureCodes, PDexPAInstitutionalProcedureCodesVS and PdexPriorAuthorization
- Endpoint Connection Type: Bundle/example-mtls-endpoint-bundle, MtlsEndpoint and Payer-Payer Exchange
- Example Diagnosis Type Codes: ExplanationOfBenefit/PDexPriorAuth1
- Example Related Claim Relationship Codes: ExplanationOfBenefit/PDexPriorAuth1
- Funds Reservation Codes: ExplanationOfBenefit/PDexPriorAuth1
- Process Priority Codes: ExplanationOfBenefit/PDexPriorAuth1 and PdexPriorAuthorization
- Provenance participant type: Bundle/1000000-1, Bundle/1000000-2... Show 13 more, Bundle/1000000-3, Bundle/3000003, Consent/no-consent-1, PDexProviderSharingConsent, Parameters/payer-multi-member-match-in, Provenance, Provenance/1000002, Provenance/1000003, Provenance/1000004, Provenance/1000005, Provenance/1000006, Provenance/1000101 and ProvenanceAgentType
- SubscriberPolicyholder Relationship Codes: Coverage/883210, Coverage/Coverage1 and Parameters/payer-multi-member-match-in
- identifierType: Bundle/1000000-1, Bundle/1000000-2... Show 13 more, Bundle/1000000-3, Coverage/883210, Coverage/Coverage1, Group/example-pdex-member-consent-constraint-group, Group/example-pdex-member-no-match-group, Matched Members, Parameters/payer-multi-member-match-in, Parameters/payer-multi-member-match-out, Patient/1, Patient/1-2, Patient/100, Patient/1001 and Patient/2002
- ActCode: Bundle/1000000-1, Bundle/1000000-2... Show 11 more, Bundle/1000000-3, Bundle/2000002, Bundle/3000002, Consent/no-consent-1, Encounter/6, Encounter/7, Encounter/8, MedicationDispense/1000001, PDexProviderSharingConsent, Parameters/payer-multi-member-match-in and PdexMedicationDispense
- ActReason: Provenance/1000101
- DataOperation: Provenance/1000101
- NullFlavor: Bundle/1000000-1, Bundle/1000000-2... Show 4 more, Bundle/1000000-3, Patient/1, Patient/1-2 and Patient/100
- ParticipationType: Parameters/payer-multi-member-match-in
- Used by permission of HL7 International, all rights reserved Creative Commons License
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- US Core DocumentReferences Category Codes: DocumentReference/123456
- US Core Provenance Participant Type Extension Codes: Bundle/1000000-1, Bundle/1000000-2... Show 8 more, Bundle/1000000-3, Bundle/3000002, Provenance, Provenance/1000001, Provenance/1000016, Provenance/1000017, Provenance/1000101 and ProvenanceAgentType
- Identifier Type: Payer 1, Payer 2, Practitioner/4, Provider 1 and Provider 2
- mTLS Object Type Code: MtlsObjectTypeVS, MtlsSignedObject and Payer-Payer Exchange
- Organization Type: Acme of CT and OrgTypeVS
- PDex Provider Access API Attribution Code System: Attributed List of Health Plan Members for Practitioner 1122334455., PDexMemberMatchGroup, PDexMemberNoMatchGroup, PDexMultiMemberMatchResultVS and PDexProviderGroup
- PDex Multi-Member Match Result Code System: Group/example-pdex-member-consent-constraint-group, Group/example-pdex-member-no-match-group... Show 6 more, Matched Members, PDexMemberMatchGroup, PDexMemberNoMatchGroup, PDexMultiMemberMatchResultVS, PDexProviderGroup and Parameters/payer-multi-member-match-out
- Prior Authorization Values: ExplanationOfBenefit/PDexPriorAuth1, PdexPriorAuthorization and PriorAuthorizationAmounts
- Provenance Roles: Provenance and ProvenanceAgentType
- Provenance Payer Data Source Format: Bundle/1000000-1, Bundle/1000000-2... Show 13 more, Bundle/1000000-3, Bundle/3000002, Bundle/3000003, Provenance, Provenance/1000001, Provenance/1000002, Provenance/1000003, Provenance/1000004, Provenance/1000005, Provenance/1000006, Provenance/1000016, ProvenancePayerSourceFormat and ProvenanceSourceFrom
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