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-Member-Match Response Example - XML Representation

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<Parameters xmlns="http://hl7.org/fhir">
  <id value="provider-member-match-response-001"/>
  <parameter>
    <name value="MatchedMembers"/>
    <resource>
      <Group>
        <id value="matched-treatment-relationship-group-001"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><h2>Matched Members with Treatment Relationships</h2><p>Members with confirmed treatment relationships who are authorized for provider data access</p></div>
        </text>
        <identifier>
          <system value="http://example.org/payer/match-groups"/>
          <value value="MTG-2024-12-16-001"/>
          <assigner>
            <display value="Example Payer"/>
          </assigner>
        </identifier>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="1982947230"/>
          <assigner>
            <display value="Provider Organization"/>
          </assigner>
        </identifier>
        <active value="true"/>
        <type value="person"/>
        <actual value="true"/>
        <code>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS"/>
            <code value="match"/>
            <display value="Matched"/>
          </coding>
        </code>
        <quantity value="2"/>
        <managingEntity>
          <identifier>
            <system value="http://hl7.org/fhir/sid/us-npi"/>
            <value value="5555555555"/>
          </identifier>
          <display value="Current Payer"/>
        </managingEntity>
        <characteristic>
          <code>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS"/>
              <code value="match"/>
              <display value="Matched"/>
            </coding>
          </code>
          <valueReference>
            <identifier>
              <system value="http://hl7.org/fhir/sid/us-npi"/>
              <value value="1982947230"/>
            </identifier>
            <display value="Provider Organization"/>
          </valueReference>
          <exclude value="false"/>
          <period>
            <start value="2024-12-16"/>
          </period>
        </characteristic>
        <member>
          <entity>
            <reference value="Patient/payer-member-001"/>
            <display value="Robert Michael Johnson - Payer Member"/>
          </entity>
          <inactive value="false"/>
        </member>
        <member>
          <entity>
            <reference value="Patient/payer-member-002"/>
            <display value="Sarah Elizabeth Williams - Payer Member"/>
          </entity>
          <inactive value="false"/>
        </member>
      </Group>
    </resource>
  </parameter>
  <parameter>
    <name value="NonMatchedMembers"/>
    <resource>
      <Group>
        <id value="nomatch-group-001"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><h2>Non-Matched Members</h2><p>Members submitted by provider that were not found in payer system</p></div>
        </text>
        <identifier>
          <system value="http://example.org/payer/match-groups"/>
          <value value="NMG-2024-12-16-001"/>
          <assigner>
            <display value="Example Payer"/>
          </assigner>
        </identifier>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="1982947230"/>
          <assigner>
            <display value="Provider Organization"/>
          </assigner>
        </identifier>
        <active value="true"/>
        <type value="person"/>
        <actual value="true"/>
        <code>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS"/>
            <code value="nomatch"/>
            <display value="Not Matched"/>
          </coding>
        </code>
        <quantity value="0"/>
        <managingEntity>
          <identifier>
            <system value="http://hl7.org/fhir/sid/us-npi"/>
            <value value="5555555555"/>
          </identifier>
          <display value="Current Payer"/>
        </managingEntity>
        <characteristic>
          <code>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS"/>
              <code value="nomatch"/>
              <display value="Not Matched"/>
            </coding>
          </code>
          <exclude value="false"/>
          <period>
            <start value="2024-12-16"/>
          </period>
        </characteristic>
      </Group>
    </resource>
  </parameter>
  <parameter>
    <name value="TreatmentAttestationConstrainedMembers"/>
    <resource>
      <Group>
        <id value="attestation-constrained-group-001"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><h2>Treatment Attestation Constrained</h2><p>Members for whom treatment attestation could not be verified or does not meet payer requirements</p></div>
        </text>
        <identifier>
          <system value="http://example.org/payer/match-groups"/>
          <value value="ACG-2024-12-16-001"/>
          <assigner>
            <display value="Example Payer"/>
          </assigner>
        </identifier>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="1982947230"/>
          <assigner>
            <display value="Provider Organization"/>
          </assigner>
        </identifier>
        <active value="true"/>
        <type value="person"/>
        <actual value="true"/>
        <code>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS"/>
            <code value="nomatch"/>
            <display value="Not Matched"/>
          </coding>
        </code>
        <quantity value="0"/>
        <managingEntity>
          <identifier>
            <system value="http://hl7.org/fhir/sid/us-npi"/>
            <value value="5555555555"/>
          </identifier>
          <display value="Current Payer"/>
        </managingEntity>
        <characteristic>
          <code>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS"/>
              <code value="nomatch"/>
              <display value="Not Matched"/>
            </coding>
          </code>
          <exclude value="false"/>
          <period>
            <start value="2024-12-16"/>
          </period>
        </characteristic>
      </Group>
    </resource>
  </parameter>
  <parameter>
    <name value="OptOutConstrainedMembers"/>
    <resource>
      <Group>
        <id value="optout-constrained-group-001"/>
        <text>
          <status value="generated"/>
          <div xmlns="http://www.w3.org/1999/xhtml"><h2>Members who have Opted-Out</h2><p>Members found but who have exercised opt-out rights</p></div>
        </text>
        <identifier>
          <system value="http://example.org/payer/match-groups"/>
          <value value="OOG-2024-12-16-001"/>
          <assigner>
            <display value="Example Payer"/>
          </assigner>
        </identifier>
        <identifier>
          <system value="http://hl7.org/fhir/sid/us-npi"/>
          <value value="1982947230"/>
          <assigner>
            <display value="Provider Organization"/>
          </assigner>
        </identifier>
        <active value="true"/>
        <type value="person"/>
        <actual value="true"/>
        <code>
          <coding>
            <system
                    value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS"/>
            <code value="nomatch"/>
            <display value="Not Matched"/>
          </coding>
        </code>
        <quantity value="0"/>
        <managingEntity>
          <identifier>
            <system value="http://hl7.org/fhir/sid/us-npi"/>
            <value value="5555555555"/>
          </identifier>
          <display value="Current Payer"/>
        </managingEntity>
        <characteristic>
          <code>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS"/>
              <code value="nomatch"/>
              <display value="Not Matched"/>
            </coding>
          </code>
          <valueCodeableConcept>
            <coding>
              <system
                      value="http://hl7.org/fhir/us/davinci-pdex/CodeSystem/OptOutScopeCS"/>
              <code value="provider-specific"/>
              <display value="Provider-Specific Opt-Out"/>
            </coding>
          </valueCodeableConcept>
          <exclude value="false"/>
          <period>
            <start value="2024-12-16"/>
          </period>
        </characteristic>
      </Group>
    </resource>
  </parameter>
</Parameters>