Da Vinci Payer Data Exchange
2.1.1 - STU2 Ballot
Da Vinci Payer Data Exchange
2.1.1 - STU2 Ballot
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
{
"resourceType" : "Parameters",
"id" : "payer-multi-member-match-in",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-parameters-multi-member-match-bundle-in"
]
},
"parameter" : [
{
"name" : "MemberBundle",
"part" : [
{
"name" : "MemberPatient",
"resource" : {
"resourceType" : "Patient",
"id" : "1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Default Generated text for resource.</div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MB"
}
]
},
"system" : "http://example.org/old-payer/identifiers/member",
"value" : "55678",
"assigner" : {
"display" : "Old Payer"
}
}
],
"name" : [
{
"use" : "official",
"family" : "Person",
"given" : [
"Patricia",
"Ann"
]
}
],
"gender" : "female",
"birthDate" : "1974-12-25"
}
},
{
"name" : "CoverageToMatch",
"resource" : {
"resourceType" : "Coverage",
"id" : "9876B1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Default Generated text for resource.</div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MB"
}
]
},
"system" : "http://example.org/old-payer",
"value" : "DH10001235"
}
],
"status" : "draft",
"subscriberId" : "1234564321",
"beneficiary" : {
🔗 "reference" : "Patient/1"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"period" : {
"start" : "2011-05-23",
"end" : "2012-05-23"
},
"payor" : [
{
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "9876543210"
},
"display" : "Old Health Plan"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "group"
},
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subplan"
}
]
},
"value" : "P7"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
},
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "class"
}
]
},
"value" : "SILVER"
}
]
}
},
{
"name" : "Consent",
"resource" : {
"resourceType" : "Consent",
"id" : "consent-1",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Default Generated text for resource.</div>"
},
"status" : "active",
"scope" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/consentscope",
"code" : "patient-privacy"
}
]
},
"category" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "IDSCL"
}
]
}
],
"patient" : {
🔗 "reference" : "Patient/1"
},
"performer" : [
{
🔗 "reference" : "Patient/1"
}
],
"sourceReference" : {
"reference" : "http://example.org/DocumentReference/someconsent-1"
},
"policy" : [
{
"uri" : "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition-hrex-consent.html#regular"
}
],
"provision" : {
"type" : "permit",
"period" : {
"start" : "2023-12-01",
"end" : "2024-03-31"
},
"actor" : [
{
"role" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
"code" : "performer"
}
]
},
"reference" : {
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "9876543210"
},
"display" : "Old Health Plan"
}
},
{
"role" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code" : "IRCP"
}
]
},
"reference" : {
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "0123456789"
},
"display" : "New Health Plan"
}
}
],
"action" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/consentaction",
"code" : "disclose"
}
]
}
]
}
}
},
{
"name" : "CoverageToLink",
"resource" : {
"resourceType" : "Coverage",
"id" : "AA87654",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Default Generated text for resource.</div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MB"
}
]
},
"system" : "http://example.org/new-payer/identifiers/coverage",
"value" : "234567"
}
],
"status" : "active",
"subscriberId" : "23456754321",
"beneficiary" : {
🔗 "reference" : "Patient/1"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"payor" : [
{
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "0123456789"
},
"display" : "New Health Plan"
}
]
}
}
]
},
{
"name" : "MemberBundle",
"part" : [
{
"name" : "MemberPatient",
"resource" : {
"resourceType" : "Patient",
"id" : "2",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Default Generated text for resource.</div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MB"
}
]
},
"system" : "http://example.org/old-payer/identifiers/member",
"value" : "45567",
"assigner" : {
"display" : "Old Payer"
}
}
],
"name" : [
{
"use" : "official",
"family" : "Smith",
"given" : [
"William",
"John"
]
}
],
"gender" : "female",
"birthDate" : "1958-12-25"
}
},
{
"name" : "CoverageToMatch",
"resource" : {
"resourceType" : "Coverage",
"id" : "876B10",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Default Generated text for resource.</div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MB"
}
]
},
"system" : "http://example.org/old-payer",
"value" : "DH10001235"
}
],
"status" : "draft",
"subscriberId" : "9876543789",
"beneficiary" : {
"reference" : "Patient/2"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"period" : {
"start" : "2011-05-23",
"end" : "2012-05-23"
},
"payor" : [
{
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "9876543210"
},
"display" : "Old Health Plan"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "group"
},
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "subplan"
}
]
},
"value" : "P7"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
},
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "class"
}
]
},
"value" : "SILVER"
}
]
}
},
{
"name" : "Consent",
"resource" : {
"resourceType" : "Consent",
"id" : "consent-2",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Default Generated text for resource.</div>"
},
"status" : "active",
"scope" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/consentscope",
"code" : "patient-privacy"
}
]
},
"category" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "IDSCL"
}
]
}
],
"patient" : {
"reference" : "Patient/2"
},
"performer" : [
{
"reference" : "Patient/2"
}
],
"sourceReference" : {
"reference" : "http://example.org/DocumentReference/someconsen-2"
},
"policy" : [
{
"uri" : "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition-hrex-consent.html#regular"
}
],
"provision" : {
"type" : "permit",
"period" : {
"start" : "2023-12-01",
"end" : "2024-03-31"
},
"actor" : [
{
"role" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
"code" : "performer"
}
]
},
"reference" : {
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "9876543210"
},
"display" : "Old Health Plan"
}
},
{
"role" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code" : "IRCP"
}
]
},
"reference" : {
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "0123456789"
},
"display" : "New Health Plan"
}
}
],
"action" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/consentaction",
"code" : "disclose"
}
]
}
]
}
}
},
{
"name" : "CoverageToLink",
"resource" : {
"resourceType" : "Coverage",
"id" : "AA87654",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Default Generated text for resource.</div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MB"
}
]
},
"system" : "http://example.org/new-payer/identifiers/coverage",
"value" : "234567"
}
],
"status" : "active",
"subscriberId" : "432156789",
"beneficiary" : {
"reference" : "Patient/2"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"payor" : [
{
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "0123456789"
},
"display" : "New Health Plan"
}
]
}
}
]
}
]
}
IG © 2024+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pdex#2.1.1 based on FHIR 4.0.1. Generated 2024-11-20
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