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 Bulk Member Match Request Example - JSON Representation

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    {
      "resourceType" : "Parameters",
      "id" : "provider-bulk-member-match-in",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-parameters-multi-member-match-bundle-in"
        ]
      },
      "parameter" : [
        {
          "name" : "MemberBundle",
          "part" : [
            {
              "name" : "MemberPatient",
              "resource" : {
                "resourceType" : "Patient",
                "id" : "patient-provider-1",
                "text" : {
                  "status" : "generated",
                  "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Patient Patricia Ann Person</div>"
                },
                "identifier" : [
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code" : "MB"
                        }
                      ]
                    },
                    "system" : "http://example.org/provider-emr/identifiers/patient",
                    "value" : "EMR-98765",
                    "assigner" : {
                      "display" : "Provider 1 EMR System"
                    }
                  }
                ],
                "name" : [
                  {
                    "use" : "official",
                    "family" : "Person",
                    "given" : [
                      "Patricia",
                      "Ann"
                    ]
                  }
                ],
                "gender" : "female",
                "birthDate" : "1974-12-25"
              }
            },
            {
              "name" : "CoverageToMatch",
              "resource" : {
                "resourceType" : "Coverage",
                "id" : "coverage-provider-1",
                "text" : {
                  "status" : "generated",
                  "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Coverage information from insurance card</div>"
                },
                "identifier" : [
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code" : "MB"
                        }
                      ]
                    },
                    "system" : "http://example.org/health-plan",
                    "value" : "HP-12345678"
                  }
                ],
                "status" : "active",
                "subscriberId" : "SUB-987654321",
                "beneficiary" : {
                  "reference" : "Patient/patient-provider-1"
                },
                "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" : "1234567890"
                    },
                    "display" : "Example Health Plan"
                  }
                ],
                "class" : [
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                          "code" : "group"
                        }
                      ]
                    },
                    "value" : "GRP-001"
                  },
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                          "code" : "plan"
                        }
                      ]
                    },
                    "value" : "PLAN-GOLD"
                  }
                ]
              }
            },
            {
              "name" : "Consent",
              "resource" : {
                "resourceType" : "Consent",
                "id" : "consent-provider-1",
                "text" : {
                  "status" : "generated",
                  "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Provider attestation to treatment relationship</div>"
                },
                "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-provider-1"
                },
                "dateTime" : "2024-11-14T10:30:00Z",
                "performer" : [
                  {
                    🔗 "reference" : "Practitioner/4",
                    "display" : "Dr. Susan Smith"
                  }
                ],
                "sourceReference" : {
                  🔗 "reference" : "DocumentReference/provider-attestation-doc-1"
                },
                "policy" : [
                  {
                    "uri" : "https://example.org/provider-attestation-policy"
                  }
                ],
                "verification" : [
                  {
                    "verified" : true,
                    "verifiedWith" : {
                      🔗 "reference" : "Organization/ProviderOrg1"
                    },
                    "verificationDate" : "2024-11-14T10:30:00Z"
                  }
                ],
                "provision" : {
                  "type" : "permit",
                  "period" : {
                    "start" : "2024-01-15"
                  },
                  "actor" : [
                    {
                      "role" : {
                        "coding" : [
                          {
                            "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                            "code" : "IRCP"
                          }
                        ]
                      },
                      "reference" : {
                        "identifier" : {
                          "system" : "http://hl7.org/fhir/sid/us-npi",
                          "value" : "1982943213"
                        },
                        "display" : "Dr. Susan Smith"
                      }
                    },
                    {
                      "role" : {
                        "coding" : [
                          {
                            "system" : "http://terminology.hl7.org/CodeSystem/v3-RoleClass",
                            "code" : "PROV"
                          }
                        ]
                      },
                      "reference" : {
                        "identifier" : {
                          "system" : "http://hl7.org/fhir/sid/us-npi",
                          "value" : "1982947230"
                        },
                        "display" : "Provider 1"
                      }
                    }
                  ],
                  "purpose" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                      "code" : "TREAT"
                    },
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                      "code" : "HPAYMT"
                    },
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                      "code" : "HOPERAT"
                    }
                  ]
                }
              }
            }
          ]
        }
      ]
    }