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

## Change History

Page standards status: Informative

Previous Page - Member-Authorized OAuth2 Exchange

### STU 2.1.1 Update

| JIRA Ticket | Change | |———————————————————|—————————————————————————————————–| | FHIR-50184x | Details related to notifications for bulk response missing for Provider access API and Payer to Payer API | | FHIR-50183x | Provider access details in the payer-payer section of the IG at 6.4.4 |

### STU 2.1.0-ballot Reconciliation

JIRA Ticket | Change
--- | ---
FHIR-50105 | Clarify Asynchronous Response for Bulk Member Match
FHIR-49110 | Optional inclusion of Financials in Provider Access API to support VBC use cases
STU 2.1 Block Vote 3 |
FHIR-48991 | Fix broken Links and other issues identified in QA Report
FHIR-48922 | $davinci-data-export param exportType should be mandatory
FHIR-48088 | Code Systems should be in THO or be granted an exemption
FHIR-48079 | Separate API details from the Data payload section
FHIR-48063 | Member-authorized exchange is underspecified
FHIR-48061 | "PDex Implementation, Actors, Interactions, Data Payloads and Methods" page important or redundant?
FHIR-48057 | Missing must support definition
FHIR-48036 | Separate data mapping and patient matching discussion
FHIR-48023 | Sub-field must support language inconsistency
FHIR-47778 | Include the full HRex privacy and security requirements
FHIR-47761 | Security and Privacy and Access Permissions Page not accessible
FHIR-47562 | Please add a "Plain Language Summary about HL7 and this Guide" to the home page.
FHIR-47056 | Clarify OAuth2.0 workflow for Payer to Payer
FHIR-47053 | Require MemberId parameter to be returned in $member-match
STU 2.1 Block Vote 2 |
FHIR-48701 | AppointmentBook hook usage for Provider Access use case
FHIR-48313 | What are implementers supposed to follow for exportType
FHIR-48077 | provenance details are spread across several pages and are inconsistently linked
FHIR-48073 | Use Case Scenarios page not easily reachable
FHIR-48072 | Data Mapping Conformance Requirements
FHIR-48070 | integrate separate sections on data mapping
FHIR-48058 | Unclear references to Da Vinci ATR
FHIR-48037 | CapabilityStatements don't belong under Data Mapping
FHIR-47057 | Don't require mapping claims data to US Core resources if sending as ExplanationOfBenefit resources
FHIR-47055 | Don't require five year time limit on bulk Payer to Payer exchange
FHIR-47054 | Make saving Provenance information received through Payer to Payer optional
FHIR-46761 | Add Prev / bottom / Next to header/footer
STU 2.1 Block Vote 1 |
FHIR-48675 | Add Hyperlink to PDex Server Capability Statement
FHIR-48369 | Conflicting statements on OAuth-authorized exchange
FHIR-48076 | With Mod: Remove superseded CDS Hooks page
FHIR-48074 | With Mod: provider-controlled information requests and filtering page not easily reachable
FHIR-48056 | With Mod: Multiple CapabilityStatement descriptions not in sync and should be collapsed
FHIR-47794 | Change SHOULD to SHALL
FHIR-47792 | rewrite for clarity and grammar
FHIR-47789 | Not Persuasive: Change SHOULD to SHALL
FHIR-47787 | Clarify concept of changed status
FHIR-47786 | Change SHOULD to SHALL
FHIR-47785 | Change SHOULD to SHALL
FHIR-47784 | Confusing Phrase
FHIR-47783 | Clarify the Regulatory requirements
FHIR-46681 | Add US Core 7.0.0 support to the IG
STU 2.1 Technical Corrections |
TC:FHIR-48071 | Rendered text in the middle of example json
TC:FHIR-48068 | Reference to profile pages instead of data mapping pages
TC:FHIR-48067 | mebedded -> embedded
TC:FHIR-48065 | member health history us core sections should be subsections
TC:FHIR-48040 | device row in capability statement table shifted over incorrectl
TC:FHIR-48039 | un-rendered link on the capability statement page
TC:FHIR-48024 | Incorrect Section Numbering
TC:FHIR-48022 | Oral Basis Profile is the Dental Profile?
TC:FHIR-47973 | Large number of technical corrections
TC:FHIR-47788 | grammatical errors and typos

### STU 2.1.0 Update

JIRA Ticket | Change
--- | ---
TC:FHIR-46479 | Change CARIN Blue Button IG link to 2.1.0-snapshot1
FHIR-46476 | Provide guidance on handling of unstructured data for exchange via Payer-to-Payer API
FHIR-45992 | Overview page should mention different APIs instead of exchange methods
FHIR-42964 FHIR-43375 | Add more Clarity to Step 3- Request Access token for Member Access , How to communicate the Patient ID or Member id when Request Access token for Member Access
FHIR-45969 | Specify a means to search for different types of groups.
FHIR-46444 | Add Endpoint discovery expectations to index.html
Add links to C4BB Basis Profiles for use in Payer and PRovider APIs | Point to C4BB Basis (Non-Financial) Profiles to enable EOBs to be exchanged via Provider Access and Payer-to-Payer API. Update relevant narrative pages.
Updates from CMS Connectathon 2024-07-17 | Add comment about search parameters for _tchangehistory.mdypeFilter. Re-work introduction page to Explain the differences between the different APIs. Patient, Provider and Payer-to-Payer. Change Order Select to Encounter Start in Provider Access API Section. CDS Hooks. Should this be retired? Note to say it pre-dates CMS Regulations. Add scope for Single-member match add 6.4.6 to single-member match and change the scope to fit. Re-order Table of Contents - PDex IG not before introduction.
Updates from PDex community meeting 2024-07-12 | Use rendering provider NPI as minimum for Attribution Lists. Add EMR Role-based security Assumption. Add UDAP subject_id recommendation.
FHIR-45353 | Capturing adjudication (determination) date for pre-auth. Created WhenAdjudicated Extension to hold a DateTime element that can be used in EOB item.adjudication and adjudication.
FHIR-46132 | Define Consent Profile for Provider Access Opt-out. Make clear it is optional and provided as assistance for recording opt-out
Identify Provider Access and Payer-to-Payer as Async APIs | Add section to Payer-to-Payer Bulk and Provider Access API narrative pages to use HTTP POST and operate as Async Operations
Add new Data Payload section | Add Data Payload section to Provider Access Narrative and Payer-to-Payer bulk API narrative.
Add new Capability Statements | Add capability Statements for Provider Access and Payer-to-Payer API access.
Fix Payer-to-Payer bulk exchange workflow digram | Change from $pdex-p2p-export to $davinci-data-export
More specific Group.code value for Operation Scope | More specific Group.code value using CodeSystem URL for Operation Scope
Edited Scopes for Operations | Edited scopes for Operations used in Payer-to-Payer and Provider Access APIs
Added Informative Extension to Pages | Added Informative Extension to Pages in Sushi-config.yaml
Added Change History to Menu | Add Change History page to Menu
FHIR-45364 | Provide Use case examples for use of custom extensions in PDex Provider Group
Update Clinical-Financial picture in overview.md | Update Clinical Financial image on overview page.
FHIR-45356 | Change milsEndpoint examples to use correct code from NdhAssociatedServersTypeCS
FHIR-45355 | Removed copied NDH Extensions, Code Systems and Value Sets. Point to content in NDH 1.0.0-ballot, allowing replicated content to be removed from PDex.
FHIR-45352 | Added support for US Core 6.1.0 in addition to US Core 3.1.1. Based on L McKenzie Publishing Guidance
New MembersOptedOut Extension | Extension to capture number of Attributed Members excluded from the list through Opt-Out
TC: FHIR-44906 | Fix broken link to Bulk Data Access IG
Add DaVinci-data-export-operation to Other-igs.md | Add link to Da Vinci Data Export Operation in other-igs.md
Expand narrative for Provider Access and Payer-to-Payer APIs | Removed ExportModeVS and ExportModeCS, replaced by exportType with fragment
FHIR-44807 | Drop Must Support from item.adjudication[consumeUnits] In PDex Prior Authorization
Add Provider Access API Diagram | Created Plantuml for Provider Access API
Decision to remove optout members from Group | Remove OptOut Extension
Define OptedOut Extension to capture member optout | Added OptedOut Extension to PDexProviderGroup to record member opt out from data sharing with attributedproviders

### STU 2.0.0-ballot:Ballot Reconciliation

JIRA Ticket | Change
--- | ---
Payer-to-Payer Bulk Exchange Draft | Draft of PDex Multi Member Match Operation and Request and Response Bundles
BallotRec-Vote7 |
TC: endpoint example | Update Endpoint example with new Trust Framework certificates in Base64Binary
TC: FHIR-41675 | Remove duplicate codes from Provenance Agent Type
TC: FHIR-41497 | Missing reference to CDS Hooks diagram
TC: FHIR-41399 | Text states "US Core v3.1.1" but URL behind "US Core FHIR R4" points to US Core V 6.0.0
TC: FHIR-41398 | Typo at the bottom of section 5.0.4.3 ("4.2" vs. "5.2")
FHIR-41381 | Add narrative stating that the Prior Authorization profile also applies to the Payer to Payer use case
NDH Profiles and Extensions | Imported unpublished NDH Profiles, Extensions, CodeSystems and ValueSets into PDex for mTLS support
FHIR-41307 | Conflicting Links to HRex Coverage Profile
FHIR-41177 | Capturing adjudication (determination) date for pre-auth
FHIR-40517 | Section numbering is broken
Created Examples for mTLS | Created Examples for MtlsOrganization and MtlsEndpoint
FHIR-40357 | Possible typo in Data Mapping specification
FHIR-40239 | Missing endpoint URLs?
FHIR-36626 | Review all mappings as significant errors have been detected - Reviewed against CARIN-BB STU2
FHIR-36602 | Review all mappings as significant errors have been detected in the above mappings and are expected in other mappings.- Reviewed against CARIN-BB STU2
FHIR-36601 | Review all mappings for DiagnosticReport - Reviewed against CARIN-BB STU2
FHIR-36598 | Review all mappings for Encounter - Reviewed against CARIN-BB STU2
QA Report Fixes | Apply fixes to resolve QA Report Errors.
TC: FHIR-39434 | Update table of profiles for payer-to-payer exchange
FHIR-39424 | We need a new OperationDefinition for patient-export-pdex
FHIR-39314 | Need detail w.r.t. reconciling new session with Consent from earlier interaction
FHIR-36626 | Review all mappings as significant errors have been detected - fixed table layout and reconcile to CARIN-BB STU2 - CareTeam, Condition, Coverage, Encounter
BallotRec-Vote6 |
TC: FHIR-38767 | Typo in 5.2.1.3 Future Direction for Discovery and Registration
FHIR-38708 | Clarification on payer directory queries
FHIR-38707 | Clarifications on dynamic client registration and first token request
FHIR-38706 | Consent reference to DocumentReference in member match request clarification -
TC: FHIR-38705 | Endpoint bundle example is not valid
TC: FHIR-38696 | Wrong link - NationalDirectory Endpoint resource
FHIR-38650 | PDex defines an incorrect request pattern for Patient-level bulk export
FHIR-38097 | ExplanationOfBenefit description clarification for use of item level, header level adjudication
BallotRec-Vote5 |
FHIR-38096 | For Pdex Prior Authorization EOB, reviewAction extension not available at header level adjudication.
FHIR-37904 | Add Privacy and Security section to IG
FHIR-36598 | Review all mappings for Encounter.
FHIR-36495 | CDS Card should not return an access token
FHIR-36315 | Unclear definitions of filtering vs restricting cases
TC: FHIR-36174 | Correction in StructureDefinition-pdex-provenance
BallotRec-Vote4 |
Added mTLS Discovery Profiles | Added mTLS Discovery profiles and referenced in Payer-to-Payer Exchange page.
FHIR-37778 | Link to the HREX Coverage takes you to the Patient Demographic Profile
FHIR-37645 | Consent presentation for P2P
FHIR-37644 | Consent Revocation for P2P
FHIR-36599 | Review 835 and all mappings to diagnostics.
FHIR-36572 | Create a Formal Specification or Conformance Expectations page/section
FHIR-36462 | Incorrect Diagram, Consent considerations, everything operation (Duplicate of FHIR-36461)
FHIR-36254 | Missing details of payer-to-payer mutual authentication
FHIR-36223 | PDEX defined their own version of an already existing code system
TC: FHIR-36176 | Correction needed in ExplanationOfBenefit-PDexPriorAuth1.json
FHIR-36078 | CareTeam for a patient is not the same thing as "a random collection of Providers that treated the patient once"
BallotRec-Vote3 |
FHIR-37577 | Change use of _profile to ExplanationOfBenefit.use to filter on "preauthorization"
FHIR-37576 | Duplicate to FHIR-37577
FHIR-37546 | Consent expiration for P2P Data Exchange
FHIR-36767 | $member-match operation conformance not defined
FHIR-36629 | change from are expected to SHALL
FHIR-36601 | Review all mappings for DiagnosticReport (MedicationDispense).
FHIR-36462 | Incorrect Diagram, Consent considerations, everything operation
BallotRec-Vote2 |
FHIR-36885 | ExplanationOfBenefit.use = preauthorization
FHIR-36772 | PDEX Provenance page. Broken section
FHIR-36767 | $member-match operation conformance not defined
FHIR-36600 | Review all mappings for Coverage
FHIR-36597 | Invalid data population instruction for Condition
FHIR-36596 | Invalid data population instruction for CareTeam
FHIR-36563 | No issues; this section is dense but necessary in defining scope.
FHIR-36352 | Expand CPCDS Undefined Acronym
FHIR-36337 | Update Name Column for Lab Result
TC: FHIR-36075 | Link to US Core 3.1.1 actually links to HL7 home
TC: FHIR-36314 | Formatting fixes in Care Team element table
Ballot-Rec-Vote1 |
TC: FHIR-37366 | Vital Signs not referenced in Capability Statement
FHIR-36603 | Note that CPCDS is external and informative
FHIR-36580 | Update references to HRex to published 1.0.0 version
TC: FHIR-36575 | Make the CapabilityStatement rendering more reader friendly
FHIR-36573 | Correction: Added pages to drop-down menu
TC: FHIR-36569 | Create a Change Notes or History page
FHIR-36564 | Add clarifying markup for CPCDS mapping tables
FHIR-36562 | Add CARIN Acronym on first use
TC: FHIR-36255 | Formatting issues for PDEX server capability statement
FHIR-36237 | Sending Duplicative Data
TC: FHIR-36080 | link to published FHIR v4.0.1
TC: FHIR-36079 | removed double link to ChangeHistory

Technical Corrections are prefixed with "TC: "

### STU 2.0.0

The following changes were applied in the Proposed STU 2.0.0 update:

JIRA Ticket | Change
--- | ---
TC: FHIR-36026 | Multiple Technical Corrections
FHIR-35868 | Revert US Core References back to 3.1.1
FHIR-34308 | Update US Core and PDex inter-relationship diagram to add Prior Auth in Overview page.
FHIR-33382 | Change references to US Core to link to the current 4.0.0 version. Reverted - see FHIR-35868 above.
FHIR-33218 | Update Payer-to-Payer Exchange section to clarify use of Bulk FHIR protocols for retrieval of data for a single patient/member only. The flow has been subject to substantial assessment at multiple connectathons and test events.
FHIR-33217 | Add a PDex Prior Authorization profile, based on the EOB resource to support the exchange of Prior Authorization information with Members. Added Slices to item adjudication and added consumedunits slice
FHIR-33141 | Revert PDex Provenance Recorded definition to the US Core Provenance version
FHIR-33173 | Add clarification to use of $everything operation - superceded by updates to Payer-to-Payer exchange
FHIR-33216 | Add guidance for use of Consent resource in $member-match operation - superceded by updated to Payer-to-Payer exchange
FHIR-33713 | Add Provenance custodian record for receipt of member data from prior payer

### STU 1.0.0

First version of the PDex IG.

### STU 0.1.0

Draft of PDex IG

### STU 0.0.1

Skeleton version of PDex IG

Next Page - Credits