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 Response Example - JSON Representation

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    {
      "resourceType" : "Parameters",
      "id" : "provider-member-match-response-001",
      "parameter" : [
        {
          "name" : "MatchedMembers",
          "resource" : {
            "resourceType" : "Group",
            "id" : "matched-treatment-relationship-group-001",
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "identifier" : [
              {
                "system" : "http://example.org/payer/match-groups",
                "value" : "MTG-2024-12-16-001",
                "assigner" : {
                  "display" : "Example Payer"
                }
              },
              {
                "system" : "http://hl7.org/fhir/sid/us-npi",
                "value" : "1982947230",
                "assigner" : {
                  "display" : "Provider Organization"
                }
              }
            ],
            "active" : true,
            "type" : "person",
            "actual" : true,
            "code" : {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS",
                  "code" : "match",
                  "display" : "Matched"
                }
              ]
            },
            "quantity" : 2,
            "managingEntity" : {
              "identifier" : {
                "system" : "http://hl7.org/fhir/sid/us-npi",
                "value" : "5555555555"
              },
              "display" : "Current Payer"
            },
            "characteristic" : [
              {
                "code" : {
                  "coding" : [
                    {
                      "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS",
                      "code" : "match",
                      "display" : "Matched"
                    }
                  ]
                },
                "valueReference" : {
                  "identifier" : {
                    "system" : "http://hl7.org/fhir/sid/us-npi",
                    "value" : "1982947230"
                  },
                  "display" : "Provider Organization"
                },
                "exclude" : false,
                "period" : {
                  "start" : "2024-12-16"
                }
              }
            ],
            "member" : [
              {
                "entity" : {
                  "reference" : "Patient/payer-member-001",
                  "display" : "Robert Michael Johnson - Payer Member"
                },
                "inactive" : false
              },
              {
                "entity" : {
                  "reference" : "Patient/payer-member-002",
                  "display" : "Sarah Elizabeth Williams - Payer Member"
                },
                "inactive" : false
              }
            ]
          }
        },
        {
          "name" : "NonMatchedMembers",
          "resource" : {
            "resourceType" : "Group",
            "id" : "nomatch-group-001",
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "identifier" : [
              {
                "system" : "http://example.org/payer/match-groups",
                "value" : "NMG-2024-12-16-001",
                "assigner" : {
                  "display" : "Example Payer"
                }
              },
              {
                "system" : "http://hl7.org/fhir/sid/us-npi",
                "value" : "1982947230",
                "assigner" : {
                  "display" : "Provider Organization"
                }
              }
            ],
            "active" : true,
            "type" : "person",
            "actual" : true,
            "code" : {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS",
                  "code" : "nomatch",
                  "display" : "Not Matched"
                }
              ]
            },
            "quantity" : 0,
            "managingEntity" : {
              "identifier" : {
                "system" : "http://hl7.org/fhir/sid/us-npi",
                "value" : "5555555555"
              },
              "display" : "Current Payer"
            },
            "characteristic" : [
              {
                "code" : {
                  "coding" : [
                    {
                      "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS",
                      "code" : "nomatch",
                      "display" : "Not Matched"
                    }
                  ]
                },
                "exclude" : false,
                "period" : {
                  "start" : "2024-12-16"
                }
              }
            ]
          }
        },
        {
          "name" : "TreatmentAttestationConstrainedMembers",
          "resource" : {
            "resourceType" : "Group",
            "id" : "attestation-constrained-group-001",
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "identifier" : [
              {
                "system" : "http://example.org/payer/match-groups",
                "value" : "ACG-2024-12-16-001",
                "assigner" : {
                  "display" : "Example Payer"
                }
              },
              {
                "system" : "http://hl7.org/fhir/sid/us-npi",
                "value" : "1982947230",
                "assigner" : {
                  "display" : "Provider Organization"
                }
              }
            ],
            "active" : true,
            "type" : "person",
            "actual" : true,
            "code" : {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS",
                  "code" : "nomatch",
                  "display" : "Not Matched"
                }
              ]
            },
            "quantity" : 0,
            "managingEntity" : {
              "identifier" : {
                "system" : "http://hl7.org/fhir/sid/us-npi",
                "value" : "5555555555"
              },
              "display" : "Current Payer"
            },
            "characteristic" : [
              {
                "code" : {
                  "coding" : [
                    {
                      "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS",
                      "code" : "nomatch",
                      "display" : "Not Matched"
                    }
                  ]
                },
                "exclude" : false,
                "period" : {
                  "start" : "2024-12-16"
                }
              }
            ]
          }
        },
        {
          "name" : "OptOutConstrainedMembers",
          "resource" : {
            "resourceType" : "Group",
            "id" : "optout-constrained-group-001",
            "text" : {
              "status" : "generated",
              "div" : "<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>"
            },
            "identifier" : [
              {
                "system" : "http://example.org/payer/match-groups",
                "value" : "OOG-2024-12-16-001",
                "assigner" : {
                  "display" : "Example Payer"
                }
              },
              {
                "system" : "http://hl7.org/fhir/sid/us-npi",
                "value" : "1982947230",
                "assigner" : {
                  "display" : "Provider Organization"
                }
              }
            ],
            "active" : true,
            "type" : "person",
            "actual" : true,
            "code" : {
              "coding" : [
                {
                  "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS",
                  "code" : "nomatch",
                  "display" : "Not Matched"
                }
              ]
            },
            "quantity" : 0,
            "managingEntity" : {
              "identifier" : {
                "system" : "http://hl7.org/fhir/sid/us-npi",
                "value" : "5555555555"
              },
              "display" : "Current Payer"
            },
            "characteristic" : [
              {
                "code" : {
                  "coding" : [
                    {
                      "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/PDexMultiMemberMatchResultCS",
                      "code" : "nomatch",
                      "display" : "Not Matched"
                    }
                  ]
                },
                "valueCodeableConcept" : {
                  "coding" : [
                    {
                      "system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/OptOutScopeCS",
                      "code" : "provider-specific",
                      "display" : "Provider-Specific Opt-Out"
                    }
                  ]
                },
                "exclude" : false,
                "period" : {
                  "start" : "2024-12-16"
                }
              }
            ]
          }
        }
      ]
    }