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

## : PDex Provider-Member-Match Operation - XML Representation

Page standards status: Informative

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    <OperationDefinition xmlns="http://hl7.org/fhir">
      <id value="ProviderMemberMatch"/>
      <text>
        <status value="generated"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: OperationDefinition ProviderMemberMatch</b></p><a name="ProviderMemberMatch"> </a><a name="hcProviderMemberMatch"> </a><h3>Parameters</h3><table class="grid"><tr><td><b>Use</b></td><td><b>Name</b></td><td><b>Scope</b></td><td><b>Cardinality</b></td><td><b>Type</b></td><td><b>Binding</b></td><td><b>Documentation</b></td></tr><tr><td>IN</td><td>MembersToMatch</td><td/><td>1..*</td><td><a href="http://hl7.org/fhir/R4/parameters.html">Parameters</a></td><td/><td><div><p>Contains one or more members with patient demographics and coverage information to be matched against the payer's member records.</p>
    </div></td></tr><tr><td>OUT</td><td>MatchedMembers</td><td/><td>0..1</td><td><a href="http://hl7.org/fhir/R4/group.html">Group</a> (<a href="StructureDefinition-member-provider-treatment-relationship-group.html" title="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/member-provider-treatment-relationship-group">Member-Provider Treatment Relationship Group</a>)</td><td/><td><div><p>A Group resource containing members successfully matched and for whom a treatment relationship has been confirmed. This Group can be used with the $davinci-data-export operation to retrieve bulk data.</p>
    </div></td></tr><tr><td>OUT</td><td>NonMatchedMembers</td><td/><td>0..1</td><td><a href="http://hl7.org/fhir/R4/group.html">Group</a> (<a href="StructureDefinition-pdex-member-no-match-group.html" title="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-no-match-group">PDex Member No Match Group</a>)</td><td/><td><div><p>A Group resource containing members for whom no match could be found in the payer's member records.</p>
    </div></td></tr><tr><td>OUT</td><td>TreatmentAttestationConstrainedMembers</td><td/><td>0..1</td><td><a href="http://hl7.org/fhir/R4/group.html">Group</a> (<a href="StructureDefinition-pdex-member-no-match-group.html" title="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-no-match-group">PDex Member No Match Group</a>)</td><td/><td><div><p>A Group resource containing members for whom the provider's treatment attestation could not be verified or does not meet the payer's requirements.</p>
    </div></td></tr><tr><td>OUT</td><td>OptOutConstrainedMembers</td><td/><td>0..1</td><td><a href="http://hl7.org/fhir/R4/group.html">Group</a> (<a href="StructureDefinition-member-opt-out-group.html" title="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/member-opt-out-group">Member Opt-Out Group</a>)</td><td/><td><div><p>A Group resource containing members who have opted out of data sharing with providers or this specific provider.</p>
    </div></td></tr></table><div><p>The Group resources returned by this operation can be used as input to the $davinci-data-export operation to perform bulk member matching and retrieve the associated bulk member health history data.</p>
    </div></div>
      </text>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
        <valueCode value="fm"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
        <valueCode value="informative">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
            <valueCanonical
                            value="http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"/>
          </extension>
        </valueCode>
      </extension>
      <url
           value="http://hl7.org/fhir/us/davinci-pdex/OperationDefinition/ProviderMemberMatch"/>
      <version value="2.1.1"/>
      <name value="ProviderMemberMatch"/>
      <title value="PDex Provider-Member-Match Operation"/>
      <status value="active"/>
      <kind value="operation"/>
      <experimental value="true"/>
      <date value="2024-12-16T00:00:00Z"/>
      <publisher value="HL7 International / Financial Management"/>
      <contact>
        <name value="HL7 International / Financial Management"/>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org/Special/committees/fm"/>
        </telecom>
        <telecom>
          <system value="email"/>
          <value value="fm@lists.HL7.org"/>
        </telecom>
      </contact>
      <contact>
        <name value="Mark Scrimshire (mark.scrimshire@onyxhealth.io)"/>
        <telecom>
          <system value="email"/>
          <value value="mailto:mark.scrimshire@onyxhealth.io"/>
        </telecom>
      </contact>
      <contact>
        <name value="HL7 International - Financial Management"/>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org/Special/committees/fm"/>
        </telecom>
      </contact>
      <description
                   value="Provider-Member-Match Operation enables providers to match patient demographics and coverage information against a payer's member records. The operation returns matched members as a Group resource that can be used with the $davinci-data-export operation for bulk data retrieval. This operation aligns with the Payer-to-Payer Bulk Member Match but is designed for provider-initiated requests.

    The matched members returned in the MatchedMembers Group can be used directly with the $davinci-data-export operation on the Group resource to retrieve bulk FHIR data for all matched members. The $davinci-data-export operation will return a manifest file referencing the bulk data files containing the member health information in ndjson format."/>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="US"/>
          <display value="United States of America"/>
        </coding>
      </jurisdiction>
      <code value="provider-member-match"/>
      <comment
               value="The Group resources returned by this operation can be used as input to the $davinci-data-export operation to perform bulk member matching and retrieve the associated bulk member health history data."/>
      <system value="false"/>
      <type value="true"/>
      <instance value="false"/>
      <parameter>
        <name value="MembersToMatch"/>
        <use value="in"/>
        <min value="1"/>
        <max value="*"/>
        <documentation
                       value="Contains one or more members with patient demographics and coverage information to be matched against the payer's member records."/>
        <type value="Parameters"/>
        <part>
          <name value="MemberPatient"/>
          <use value="in"/>
          <min value="1"/>
          <max value="1"/>
          <documentation
                         value="The patient demographics for a member to be matched."/>
          <type value="Patient"/>
          <targetProfile
                         value="http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics"/>
        </part>
        <part>
          <name value="CoverageToMatch"/>
          <use value="in"/>
          <min value="1"/>
          <max value="1"/>
          <documentation
                         value="The member's existing or previous coverage information to match against."/>
          <type value="Coverage"/>
          <targetProfile
                         value="http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"/>
        </part>
        <part>
          <name value="CoverageToLink"/>
          <use value="in"/>
          <min value="0"/>
          <max value="1"/>
          <documentation
                         value="Optional: The member's new coverage information to link to (e.g., during plan transitions)."/>
          <type value="Coverage"/>
          <targetProfile
                         value="http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"/>
        </part>
        <part>
          <name value="TreatmentAttestation"/>
          <use value="in"/>
          <min value="1"/>
          <max value="1"/>
          <documentation
                         value="Provider's attestation to an active treatment relationship with the patient. This replaces the general consent with a specific treatment relationship attestation."/>
          <type value="Consent"/>
          <targetProfile
                         value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent"/>
        </part>
      </parameter>
      <parameter>
        <name value="MatchedMembers"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <documentation
                       value="A Group resource containing members successfully matched and for whom a treatment relationship has been confirmed. This Group can be used with the $davinci-data-export operation to retrieve bulk data."/>
        <type value="Group"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/member-provider-treatment-relationship-group"/>
      </parameter>
      <parameter>
        <name value="NonMatchedMembers"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <documentation
                       value="A Group resource containing members for whom no match could be found in the payer's member records."/>
        <type value="Group"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-no-match-group"/>
      </parameter>
      <parameter>
        <name value="TreatmentAttestationConstrainedMembers"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <documentation
                       value="A Group resource containing members for whom the provider's treatment attestation could not be verified or does not meet the payer's requirements."/>
        <type value="Group"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-no-match-group"/>
      </parameter>
      <parameter>
        <name value="OptOutConstrainedMembers"/>
        <use value="out"/>
        <min value="0"/>
        <max value="1"/>
        <documentation
                       value="A Group resource containing members who have opted out of data sharing with providers or this specific provider."/>
        <type value="Group"/>
        <targetProfile
                       value="http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/member-opt-out-group"/>
      </parameter>
    </OperationDefinition>