Da Vinci Payer Data Exchange
2.1.0 - STU2 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 2.1.0 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

PDex MedicationDispense

Page standards status: Informative

Previous Page - US Core Medication

The Da Vinci PDex MedicationDispense profile SHALL be used to record a member’s prescription drug claims when sharing data using the US Core 3.1.1 Implementation Guide. When using the US Core 6.1.0 Implementation Guide to exchange data the US Core MedicationDispense profile should be used.

The essential fields (Must Support or Cardinality greater than 0..*) to be provided in the Da Vinci PDex MedicationDispense profile are:

R4 Element Name Cardinality Type
MedicationDispense.status status 1..1 code
MedicationDispense.medication[x] medication[x] 1..1  
MedicationDispense.subject subject 1..1 Reference(US Core Patient )
MedicationDispense.performer.actor actor 1..1 Reference(Practitioner | PractitionerRole | Organization | Patient | Device | RelatedPerson)
MedicationDispense.substitution.wasSubstituted wasSubstituted 1..1 boolean

Table Definition

Health Plan Mapping Assistance

A collaboration of Health Plan experts has performed an evaluation of claims information and developed a mapping of data for Members to the PDex MedicationDispense profile. This is shown below as an assistance to implementers:

PDex Element Must Support Cardinality CARIN-BB Element CPCDS Element Mapping or Implementer Note
- MedicationDispense.meta.lastUpdated   0..1 ExplanationOfBenefit.meta.lastUpdated [{“163”:”EOB Last Updated Date”}]
MedicationDispense.identifier   0..* ExplanationOfBenefit.Identifier [{“35”:”RX service reference number”}]. Note: Assign Payer System URI for Unique Claim Id in MedicationDispense.identifier.system. SetClaim Id in MedicationDispense.identifier.value
MedicationDispense.status S 1..1 ExplanationOfBenefit.status [{“140”:”Claim processing status code
”}] Note: Default to “completed”
MedicationDispense.medication[x]   1..1   . Note: Enter prescription information in sub-elements below
- MedicationDispense.medicationReference     ExplanationOfBenefit.supportingInfo.code, ExplanationOfBenefit.detail.productOrService [{“79”:”NCPDP field # 408-D8 (Dispensed As Written (DAW)/Product Selection Code) https://ushik.ahrq.gov/ViewItemDetails?itemKey=200387000&system=sdo”}, {“38, 78”:”National drug code
Compound Code”}]
MedicationDispense.subject S 1..1 ExplanationOfBenefit.patient [{“Ref (1), Ref (109)”:”Member id, Patient account number”}, {“Ref (191)”:”Unique Member ID”}, {“Ref (110)”:”Medical record number”}]
- MedicationDispense.performer.function   0..1 ExplanationOfBenefit.careTeam.role [{“165”:”Care Team Role (Value pcp|Prescribing)”}]
- MedicationDispense.performer.actor   1..1 ExplanationOfBenefit.careTeam.provider [{“Ref(96,122)”:”Provider NPIs”}, {“Ref(169,172)”:”Provider Names”}, {“94, 167”:”Claum billing provider NPI, Claim billing provider name”}]
MedicationDispense.quantity   0..1 ExplanationOfBenefit.item.quantity [{““39,151””:”Quantity dispensed | Quantity Qualifier Code”}]
MedicationDispense.daysSupply   0..1 ExplanationOfBenefit.supportingInfo.valueQuantity [{“77”:”Days supply”}]
MedicationDispense.whenHandedOver   0..1 ExplanationOfBenefit.item.servicedDate [{“90”:”Service (from) date”}]

Table Definition

Example MedicationDispense Resource

An example mapping of a MedicationDispense resource is shown here for a dispense for Over-The-Counter medication - Tylenol PM (NDC code) - on hold with as needed dosage with a condition, a dose Range and an Event History:

MedicationDispense Example

Next Page - US Core MedicationRequest