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