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

: Provider Bulk Member Match Request Example - JSON Representation

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{
  "resourceType" : "Parameters",
  "id" : "provider-bulk-member-match-in",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-parameters-multi-member-match-bundle-in"
    ]
  },
  "parameter" : [
    {
      "name" : "MemberBundle",
      "part" : [
        {
          "name" : "MemberPatient",
          "resource" : {
            "resourceType" : "Patient",
            "id" : "patient-provider-1",
            "text" : {
              "status" : "generated",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient Patricia Ann Person</div>"
            },
            "identifier" : [
              {
                "type" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                      "code" : "MB"
                    }
                  ]
                },
                "system" : "http://example.org/provider-emr/identifiers/patient",
                "value" : "EMR-98765",
                "assigner" : {
                  "display" : "Provider 1 EMR System"
                }
              }
            ],
            "name" : [
              {
                "use" : "official",
                "family" : "Person",
                "given" : [
                  "Patricia",
                  "Ann"
                ]
              }
            ],
            "gender" : "female",
            "birthDate" : "1974-12-25"
          }
        },
        {
          "name" : "CoverageToMatch",
          "resource" : {
            "resourceType" : "Coverage",
            "id" : "coverage-provider-1",
            "text" : {
              "status" : "generated",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Coverage information from insurance card</div>"
            },
            "identifier" : [
              {
                "type" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                      "code" : "MB"
                    }
                  ]
                },
                "system" : "http://example.org/health-plan",
                "value" : "HP-12345678"
              }
            ],
            "status" : "active",
            "subscriberId" : "SUB-987654321",
            "beneficiary" : {
              "reference" : "Patient/patient-provider-1"
            },
            "relationship" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                  "code" : "self"
                }
              ]
            },
            "period" : {
              "start" : "2024-01-01",
              "end" : "2024-12-31"
            },
            "payor" : [
              {
                "identifier" : {
                  "system" : "http://hl7.org/fhir/sid/us-npi",
                  "value" : "1234567890"
                },
                "display" : "Example Health Plan"
              }
            ],
            "class" : [
              {
                "type" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                      "code" : "group"
                    }
                  ]
                },
                "value" : "GRP-001"
              },
              {
                "type" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                      "code" : "plan"
                    }
                  ]
                },
                "value" : "PLAN-GOLD"
              }
            ]
          }
        },
        {
          "name" : "Consent",
          "resource" : {
            "resourceType" : "Consent",
            "id" : "consent-provider-1",
            "text" : {
              "status" : "generated",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Provider attestation to treatment relationship</div>"
            },
            "status" : "active",
            "scope" : {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/consentscope",
                  "code" : "treatment"
                }
              ]
            },
            "category" : [
              {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/consentcategorycodes",
                    "code" : "treat",
                    "display" : "Treatment"
                  }
                ]
              },
              {
                "coding" : [
                  {
                    "system" : "http://loinc.org",
                    "code" : "64292-6",
                    "display" : "Release of information consent"
                  }
                ]
              }
            ],
            "patient" : {
              "reference" : "Patient/patient-provider-1"
            },
            "dateTime" : "2024-11-14T10:30:00Z",
            "performer" : [
              {
                🔗 "reference" : "Practitioner/4",
                "display" : "Dr. Susan Smith"
              }
            ],
            "sourceReference" : {
              🔗 "reference" : "DocumentReference/provider-attestation-doc-1"
            },
            "policy" : [
              {
                "uri" : "https://example.org/provider-attestation-policy"
              }
            ],
            "verification" : [
              {
                "verified" : true,
                "verifiedWith" : {
                  🔗 "reference" : "Organization/ProviderOrg1"
                },
                "verificationDate" : "2024-11-14T10:30:00Z"
              }
            ],
            "provision" : {
              "type" : "permit",
              "period" : {
                "start" : "2024-01-15"
              },
              "actor" : [
                {
                  "role" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                        "code" : "IRCP"
                      }
                    ]
                  },
                  "reference" : {
                    "identifier" : {
                      "system" : "http://hl7.org/fhir/sid/us-npi",
                      "value" : "1982943213"
                    },
                    "display" : "Dr. Susan Smith"
                  }
                },
                {
                  "role" : {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleClass",
                        "code" : "PROV"
                      }
                    ]
                  },
                  "reference" : {
                    "identifier" : {
                      "system" : "http://hl7.org/fhir/sid/us-npi",
                      "value" : "1982947230"
                    },
                    "display" : "Provider 1"
                  }
                }
              ],
              "purpose" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                  "code" : "TREAT"
                },
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                  "code" : "HPAYMT"
                },
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                  "code" : "HOPERAT"
                }
              ]
            }
          }
        }
      ]
    }
  ]
}