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

## : Provider-Member-Match Request Example - XML Representation

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    <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>