Da Vinci Payer Data Exchange
2.1.1 - STU 2.1
Da Vinci Payer Data Exchange
2.1.1 - STU 2.1
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" : "provider-member-match-request-001",
"parameter" : [
{
"name" : "MembersToMatch",
"part" : [
{
"name" : "MemberPatient",
"resource" : {
"resourceType" : "Patient",
"id" : "patient-prov-001",
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MB"
}
]
},
"system" : "http://example.org/provider-org/patient-ids",
"value" : "PAT-001",
"assigner" : {
"display" : "Provider Organization"
}
}
],
"name" : [
{
"use" : "official",
"family" : "Johnson",
"given" : [
"Robert",
"Michael"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "555-123-4567"
}
],
"gender" : "male",
"birthDate" : "1965-08-15",
"address" : [
{
"use" : "home",
"line" : [
"123 Main Street"
],
"city" : "Springfield",
"state" : "IL",
"postalCode" : "62701"
}
]
}
},
{
"name" : "CoverageToMatch",
"resource" : {
"resourceType" : "Coverage",
"id" : "coverage-to-match-001",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"
]
},
"status" : "draft",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "EHPLANS"
}
]
},
"subscriber" : {
"reference" : "Patient/patient-prov-001"
},
"subscriberId" : "12345678",
"beneficiary" : {
"reference" : "Patient/patient-prov-001"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"period" : {
"start" : "2023-01-01",
"end" : "2023-12-31"
},
"payor" : [
{
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "9876543210"
},
"display" : "Previous Health Plan"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "group"
}
]
},
"value" : "EMPLOY-12345"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
}
]
},
"value" : "PPO-GOLD"
}
]
}
},
{
"name" : "TreatmentAttestation",
"resource" : {
"resourceType" : "Consent",
"id" : "treatment-attestation-001",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent"
]
},
"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-prov-001"
},
"dateTime" : "2024-12-10T14:30:00Z",
"performer" : [
{
"reference" : "Practitioner/provider-001",
"display" : "Dr. Susan Smith, MD"
}
],
"organization" : [
{
"reference" : "Organization/provider-org-001",
"display" : "Springfield Medical Center"
}
],
"sourceReference" : {
"reference" : "DocumentReference/treatment-attestation-form-001",
"display" : "Provider Attestation Form"
},
"policy" : [
{
"authority" : "https://example.org/compliance",
"uri" : "https://example.org/provider-attestation-policy"
}
],
"provision" : {
"type" : "permit",
"period" : {
"start" : "2024-01-15"
},
"actor" : [
{
"role" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code" : "IRCP",
"display" : "information recipient"
}
]
},
"reference" : {
"reference" : "Practitioner/provider-001",
"display" : "Dr. Susan Smith"
}
}
],
"purpose" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"code" : "TREATMENT",
"display" : "Treatment"
}
]
}
}
},
{
"name" : "CoverageToLink",
"resource" : {
"resourceType" : "Coverage",
"id" : "coverage-link-001",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"
]
},
"status" : "draft",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "EHPLANS"
}
]
},
"subscriber" : {
"reference" : "Patient/patient-prov-001"
},
"subscriberId" : "NEW-12345678",
"beneficiary" : {
"reference" : "Patient/patient-prov-001"
},
"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" : "5555555555"
},
"display" : "Current Payer"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "group"
}
]
},
"value" : "EMPLOY-NEW"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
}
]
},
"value" : "PPO-PREMIUM"
}
]
}
}
]
},
{
"name" : "MembersToMatch",
"part" : [
{
"name" : "MemberPatient",
"resource" : {
"resourceType" : "Patient",
"id" : "patient-prov-002",
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MB"
}
]
},
"system" : "http://example.org/provider-org/patient-ids",
"value" : "PAT-002",
"assigner" : {
"display" : "Provider Organization"
}
}
],
"name" : [
{
"use" : "official",
"family" : "Williams",
"given" : [
"Sarah",
"Elizabeth"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "555-987-6543"
}
],
"gender" : "female",
"birthDate" : "1978-03-22",
"address" : [
{
"use" : "home",
"line" : [
"456 Oak Avenue"
],
"city" : "Columbus",
"state" : "OH",
"postalCode" : "43085"
}
]
}
},
{
"name" : "CoverageToMatch",
"resource" : {
"resourceType" : "Coverage",
"id" : "coverage-to-match-002",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"
]
},
"status" : "draft",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "EHPLANS"
}
]
},
"subscriber" : {
"reference" : "Patient/patient-prov-002"
},
"subscriberId" : "87654321",
"beneficiary" : {
"reference" : "Patient/patient-prov-002"
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"period" : {
"start" : "2023-06-01",
"end" : "2024-05-31"
},
"payor" : [
{
"identifier" : {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "1111111111"
},
"display" : "Another Health Plan"
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "group"
}
]
},
"value" : "EMPLOY-67890"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "plan"
}
]
},
"value" : "HMO-BASIC"
}
]
}
},
{
"name" : "TreatmentAttestation",
"resource" : {
"resourceType" : "Consent",
"id" : "treatment-attestation-002",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent"
]
},
"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-prov-002"
},
"dateTime" : "2024-12-09T10:15:00Z",
"performer" : [
{
"reference" : "Practitioner/provider-002",
"display" : "Dr. James Brown, MD"
}
],
"organization" : [
{
"reference" : "Organization/provider-org-002",
"display" : "Columbus Clinic"
}
],
"sourceReference" : {
"reference" : "DocumentReference/treatment-attestation-form-002",
"display" : "Provider Attestation Form"
},
"policy" : [
{
"uri" : "https://example.org/provider-attestation-policy"
}
],
"provision" : {
"type" : "permit",
"period" : {
"start" : "2024-02-01"
},
"actor" : [
{
"role" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
"code" : "IRCP",
"display" : "information recipient"
}
]
},
"reference" : {
"reference" : "Practitioner/provider-002",
"display" : "Dr. James Brown"
}
}
],
"purpose" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
"code" : "TREATMENT",
"display" : "Treatment"
}
]
}
}
}
]
}
]
}
IG © 2024+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pdex#2.1.1 based on FHIR 4.0.1. Generated 2025-12-18
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