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
@prefix fhir: <http://hl7.org/fhir/> .
@prefix loinc: <https://loinc.org/rdf/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:Parameters ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "provider-member-match-request-001"] ; #
fhir:parameter ( [
fhir:name [ fhir:v "MembersToMatch" ] ;
( fhir:part [
fhir:name [ fhir:v "MemberPatient" ] ;
( fhir:Parameters.parameter.resource [
a fhir:Patient ;
fhir:id [ fhir:v "patient-prov-001" ] ;
( fhir:identifier [
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203> ] ;
fhir:code [ fhir:v "MB" ] ] ) ] ;
fhir:system [
fhir:v "http://example.org/provider-org/patient-ids"^^xsd:anyURI ;
fhir:l <http://example.org/provider-org/patient-ids> ] ;
fhir:value [ fhir:v "PAT-001" ] ;
fhir:assigner [
fhir:display [ fhir:v "Provider Organization" ] ] ] ) ;
( fhir:name [
fhir:use [ fhir:v "official" ] ;
fhir:family [ fhir:v "Johnson" ] ;
( fhir:given [ fhir:v "Robert" ] [ fhir:v "Michael" ] ) ] ) ;
( fhir:telecom [
fhir:system [ fhir:v "phone" ] ;
fhir:value [ fhir:v "555-123-4567" ] ] ) ;
fhir:gender [ fhir:v "male" ] ;
fhir:birthDate [ fhir:v "1965-08-15"^^xsd:date ] ;
( fhir:address [
fhir:use [ fhir:v "home" ] ;
( fhir:line [ fhir:v "123 Main Street" ] ) ;
fhir:city [ fhir:v "Springfield" ] ;
fhir:state [ fhir:v "IL" ] ;
fhir:postalCode [ fhir:v "62701" ] ] ) ] ) ] [
fhir:name [ fhir:v "CoverageToMatch" ] ;
( fhir:Parameters.parameter.resource [
a fhir:Coverage ;
fhir:id [ fhir:v "coverage-to-match-001" ] ;
fhir:meta [
( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"^^xsd:anyURI ;
fhir:l <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage> ] ) ] ;
fhir:status [ fhir:v "draft" ] ;
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActCode> ] ;
fhir:code [ fhir:v "EHPLANS" ] ] ) ] ;
fhir:subscriber [
fhir:l fhir:Patient/patient-prov-001 ;
fhir:reference [ fhir:v "Patient/patient-prov-001" ] ] ;
fhir:subscriberId [ fhir:v "12345678" ] ;
fhir:beneficiary [
fhir:l fhir:Patient/patient-prov-001 ;
fhir:reference [ fhir:v "Patient/patient-prov-001" ] ] ;
fhir:relationship [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/subscriber-relationship> ] ;
fhir:code [ fhir:v "self" ] ] ) ] ;
fhir:period [
fhir:start [ fhir:v "2023-01-01"^^xsd:date ] ;
fhir:end [ fhir:v "2023-12-31"^^xsd:date ] ] ;
( fhir:payor [
fhir:identifier [
fhir:system [
fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ;
fhir:l <http://hl7.org/fhir/sid/us-npi> ] ;
fhir:value [ fhir:v "9876543210" ] ] ;
fhir:display [ fhir:v "Previous Health Plan" ] ] ) ;
( fhir:class [
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class> ] ;
fhir:code [ fhir:v "group" ] ] ) ] ;
fhir:value [ fhir:v "EMPLOY-12345" ] ] [
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class> ] ;
fhir:code [ fhir:v "plan" ] ] ) ] ;
fhir:value [ fhir:v "PPO-GOLD" ] ] ) ] ) ] [
fhir:name [ fhir:v "TreatmentAttestation" ] ;
( fhir:Parameters.parameter.resource [
a fhir:Consent ;
fhir:id [ fhir:v "treatment-attestation-001" ] ;
fhir:meta [
( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent"^^xsd:anyURI ;
fhir:l <http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent> ] ) ] ;
fhir:status [ fhir:v "active" ] ;
fhir:scope [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/consentscope"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/consentscope> ] ;
fhir:code [ fhir:v "treatment" ] ] ) ] ;
( fhir:category [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/consentcategorycodes"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/consentcategorycodes> ] ;
fhir:code [ fhir:v "treat" ] ;
fhir:display [ fhir:v "Treatment" ] ] ) ] [
( fhir:coding [
a loinc:64292-6 ;
fhir:system [
fhir:v "http://loinc.org"^^xsd:anyURI ;
fhir:l <http://loinc.org> ] ;
fhir:code [ fhir:v "64292-6" ] ;
fhir:display [ fhir:v "Release of information consent" ] ] ) ] ) ;
fhir:patient [
fhir:l fhir:Patient/patient-prov-001 ;
fhir:reference [ fhir:v "Patient/patient-prov-001" ] ] ;
fhir:dateTime [ fhir:v "2024-12-10T14:30:00Z"^^xsd:dateTime ] ;
( fhir:performer [
fhir:l fhir:Practitioner/provider-001 ;
fhir:reference [ fhir:v "Practitioner/provider-001" ] ;
fhir:display [ fhir:v "Dr. Susan Smith, MD" ] ] ) ;
( fhir:organization [
fhir:l fhir:Organization/provider-org-001 ;
fhir:reference [ fhir:v "Organization/provider-org-001" ] ;
fhir:display [ fhir:v "Springfield Medical Center" ] ] ) ;
fhir:source [
a fhir:Reference ;
fhir:l fhir:DocumentReference/treatment-attestation-form-001 ;
fhir:reference [ fhir:v "DocumentReference/treatment-attestation-form-001" ] ;
fhir:display [ fhir:v "Provider Attestation Form" ] ] ;
( fhir:policy [
fhir:authority [
fhir:v "https://example.org/compliance"^^xsd:anyURI ;
fhir:l <https://example.org/compliance> ] ;
fhir:uri [
fhir:v "https://example.org/provider-attestation-policy"^^xsd:anyURI ;
fhir:l <https://example.org/provider-attestation-policy> ] ] ) ;
fhir:provision [
fhir:type [ fhir:v "permit" ] ;
fhir:period [
fhir:start [ fhir:v "2024-01-15"^^xsd:date ] ] ;
( fhir:actor [
fhir:role [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/v3-ParticipationType"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/v3-ParticipationType> ] ;
fhir:code [ fhir:v "IRCP" ] ;
fhir:display [ fhir:v "information recipient" ] ] ) ] ;
fhir:reference [
fhir:l fhir:Practitioner/provider-001 ;
fhir:reference [ fhir:v "Practitioner/provider-001" ] ;
fhir:display [ fhir:v "Dr. Susan Smith" ] ] ] ) ;
( fhir:purpose [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActReason"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActReason> ] ;
fhir:code [ fhir:v "TREATMENT" ] ;
fhir:display [ fhir:v "Treatment" ] ] ) ] ] ) ] [
fhir:name [ fhir:v "CoverageToLink" ] ;
( fhir:Parameters.parameter.resource [
a fhir:Coverage ;
fhir:id [ fhir:v "coverage-link-001" ] ;
fhir:meta [
( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"^^xsd:anyURI ;
fhir:l <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage> ] ) ] ;
fhir:status [ fhir:v "draft" ] ;
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActCode> ] ;
fhir:code [ fhir:v "EHPLANS" ] ] ) ] ;
fhir:subscriber [
fhir:l fhir:Patient/patient-prov-001 ;
fhir:reference [ fhir:v "Patient/patient-prov-001" ] ] ;
fhir:subscriberId [ fhir:v "NEW-12345678" ] ;
fhir:beneficiary [
fhir:l fhir:Patient/patient-prov-001 ;
fhir:reference [ fhir:v "Patient/patient-prov-001" ] ] ;
fhir:relationship [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/subscriber-relationship> ] ;
fhir:code [ fhir:v "self" ] ] ) ] ;
fhir:period [
fhir:start [ fhir:v "2024-01-01"^^xsd:date ] ;
fhir:end [ fhir:v "2024-12-31"^^xsd:date ] ] ;
( fhir:payor [
fhir:identifier [
fhir:system [
fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ;
fhir:l <http://hl7.org/fhir/sid/us-npi> ] ;
fhir:value [ fhir:v "5555555555" ] ] ;
fhir:display [ fhir:v "Current Payer" ] ] ) ;
( fhir:class [
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class> ] ;
fhir:code [ fhir:v "group" ] ] ) ] ;
fhir:value [ fhir:v "EMPLOY-NEW" ] ] [
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class> ] ;
fhir:code [ fhir:v "plan" ] ] ) ] ;
fhir:value [ fhir:v "PPO-PREMIUM" ] ] ) ] ) ] )
] [
fhir:name [ fhir:v "MembersToMatch" ] ;
( fhir:part [
fhir:name [ fhir:v "MemberPatient" ] ;
( fhir:Parameters.parameter.resource [
a fhir:Patient ;
fhir:id [ fhir:v "patient-prov-002" ] ;
( fhir:identifier [
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203> ] ;
fhir:code [ fhir:v "MB" ] ] ) ] ;
fhir:system [
fhir:v "http://example.org/provider-org/patient-ids"^^xsd:anyURI ;
fhir:l <http://example.org/provider-org/patient-ids> ] ;
fhir:value [ fhir:v "PAT-002" ] ;
fhir:assigner [
fhir:display [ fhir:v "Provider Organization" ] ] ] ) ;
( fhir:name [
fhir:use [ fhir:v "official" ] ;
fhir:family [ fhir:v "Williams" ] ;
( fhir:given [ fhir:v "Sarah" ] [ fhir:v "Elizabeth" ] ) ] ) ;
( fhir:telecom [
fhir:system [ fhir:v "phone" ] ;
fhir:value [ fhir:v "555-987-6543" ] ] ) ;
fhir:gender [ fhir:v "female" ] ;
fhir:birthDate [ fhir:v "1978-03-22"^^xsd:date ] ;
( fhir:address [
fhir:use [ fhir:v "home" ] ;
( fhir:line [ fhir:v "456 Oak Avenue" ] ) ;
fhir:city [ fhir:v "Columbus" ] ;
fhir:state [ fhir:v "OH" ] ;
fhir:postalCode [ fhir:v "43085" ] ] ) ] ) ] [
fhir:name [ fhir:v "CoverageToMatch" ] ;
( fhir:Parameters.parameter.resource [
a fhir:Coverage ;
fhir:id [ fhir:v "coverage-to-match-002" ] ;
fhir:meta [
( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"^^xsd:anyURI ;
fhir:l <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage> ] ) ] ;
fhir:status [ fhir:v "draft" ] ;
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActCode> ] ;
fhir:code [ fhir:v "EHPLANS" ] ] ) ] ;
fhir:subscriber [
fhir:l fhir:Patient/patient-prov-002 ;
fhir:reference [ fhir:v "Patient/patient-prov-002" ] ] ;
fhir:subscriberId [ fhir:v "87654321" ] ;
fhir:beneficiary [
fhir:l fhir:Patient/patient-prov-002 ;
fhir:reference [ fhir:v "Patient/patient-prov-002" ] ] ;
fhir:relationship [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/subscriber-relationship> ] ;
fhir:code [ fhir:v "self" ] ] ) ] ;
fhir:period [
fhir:start [ fhir:v "2023-06-01"^^xsd:date ] ;
fhir:end [ fhir:v "2024-05-31"^^xsd:date ] ] ;
( fhir:payor [
fhir:identifier [
fhir:system [
fhir:v "http://hl7.org/fhir/sid/us-npi"^^xsd:anyURI ;
fhir:l <http://hl7.org/fhir/sid/us-npi> ] ;
fhir:value [ fhir:v "1111111111" ] ] ;
fhir:display [ fhir:v "Another Health Plan" ] ] ) ;
( fhir:class [
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class> ] ;
fhir:code [ fhir:v "group" ] ] ) ] ;
fhir:value [ fhir:v "EMPLOY-67890" ] ] [
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class> ] ;
fhir:code [ fhir:v "plan" ] ] ) ] ;
fhir:value [ fhir:v "HMO-BASIC" ] ] ) ] ) ] [
fhir:name [ fhir:v "TreatmentAttestation" ] ;
( fhir:Parameters.parameter.resource [
a fhir:Consent ;
fhir:id [ fhir:v "treatment-attestation-002" ] ;
fhir:meta [
( fhir:profile [
fhir:v "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent"^^xsd:anyURI ;
fhir:l <http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent> ] ) ] ;
fhir:status [ fhir:v "active" ] ;
fhir:scope [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/consentscope"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/consentscope> ] ;
fhir:code [ fhir:v "treatment" ] ] ) ] ;
( fhir:category [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/consentcategorycodes"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/consentcategorycodes> ] ;
fhir:code [ fhir:v "treat" ] ;
fhir:display [ fhir:v "Treatment" ] ] ) ] [
( fhir:coding [
a loinc:64292-6 ;
fhir:system [
fhir:v "http://loinc.org"^^xsd:anyURI ;
fhir:l <http://loinc.org> ] ;
fhir:code [ fhir:v "64292-6" ] ;
fhir:display [ fhir:v "Release of information consent" ] ] ) ] ) ;
fhir:patient [
fhir:l fhir:Patient/patient-prov-002 ;
fhir:reference [ fhir:v "Patient/patient-prov-002" ] ] ;
fhir:dateTime [ fhir:v "2024-12-09T10:15:00Z"^^xsd:dateTime ] ;
( fhir:performer [
fhir:l fhir:Practitioner/provider-002 ;
fhir:reference [ fhir:v "Practitioner/provider-002" ] ;
fhir:display [ fhir:v "Dr. James Brown, MD" ] ] ) ;
( fhir:organization [
fhir:l fhir:Organization/provider-org-002 ;
fhir:reference [ fhir:v "Organization/provider-org-002" ] ;
fhir:display [ fhir:v "Columbus Clinic" ] ] ) ;
fhir:source [
a fhir:Reference ;
fhir:l fhir:DocumentReference/treatment-attestation-form-002 ;
fhir:reference [ fhir:v "DocumentReference/treatment-attestation-form-002" ] ;
fhir:display [ fhir:v "Provider Attestation Form" ] ] ;
( fhir:policy [
fhir:uri [
fhir:v "https://example.org/provider-attestation-policy"^^xsd:anyURI ;
fhir:l <https://example.org/provider-attestation-policy> ] ] ) ;
fhir:provision [
fhir:type [ fhir:v "permit" ] ;
fhir:period [
fhir:start [ fhir:v "2024-02-01"^^xsd:date ] ] ;
( fhir:actor [
fhir:role [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/v3-ParticipationType"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/v3-ParticipationType> ] ;
fhir:code [ fhir:v "IRCP" ] ;
fhir:display [ fhir:v "information recipient" ] ] ) ] ;
fhir:reference [
fhir:l fhir:Practitioner/provider-002 ;
fhir:reference [ fhir:v "Practitioner/provider-002" ] ;
fhir:display [ fhir:v "Dr. James Brown" ] ] ] ) ;
( fhir:purpose [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActReason"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActReason> ] ;
fhir:code [ fhir:v "TREATMENT" ] ;
fhir:display [ fhir:v "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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