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 - TTL Representation

Page standards status: Informative

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:OperationDefinition ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "ProviderMemberMatch"] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<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>\n</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>\n</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>\n</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>\n</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>\n</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>\n</div></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:extension ( [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-wg>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "fm"     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "informative" ;
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom>         ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex>         ]       ] )     ]
      ] ) ; #
      fhir:url [
    fhir:v "http://hl7.org/fhir/us/davinci-pdex/OperationDefinition/ProviderMemberMatch"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pdex/OperationDefinition/ProviderMemberMatch>
      ] ; #
      fhir:version [ fhir:v "2.1.1"] ; #
      fhir:name [ fhir:v "ProviderMemberMatch"] ; #
      fhir:title [ fhir:v "PDex Provider-Member-Match Operation"] ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:kind [ fhir:v "operation"] ; #
      fhir:experimental [ fhir:v true] ; #
      fhir:date [ fhir:v "2024-12-16T00:00:00Z"^^xsd:dateTime] ; #
      fhir:publisher [ fhir:v "HL7 International / Financial Management"] ; #
      fhir:contact ( [
    fhir:name [ fhir:v "HL7 International / Financial Management" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ]     ] [
    fhir:system [ fhir:v "email" ] ;
    fhir:value [ fhir:v "fm@lists.HL7.org" ]     ] )
      ] [
    fhir:name [ fhir:v "Mark Scrimshire (mark.scrimshire@onyxhealth.io)" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "email" ] ;
    fhir:value [ fhir:v "mailto:mark.scrimshire@onyxhealth.io" ]     ] )
      ] [
    fhir:name [ fhir:v "HL7 International - Financial Management" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://www.hl7.org/Special/committees/fm" ]     ] )
      ] ) ; #
      fhir:description [ fhir:v "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.\n\nThe 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."] ; #
      fhir:jurisdiction ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ;
    fhir:l <urn:iso:std:iso:3166>       ] ;
    fhir:code [ fhir:v "US" ] ;
    fhir:display [ fhir:v "United States of America" ]     ] )
      ] ) ; #
      fhir:code [ fhir:v "provider-member-match"] ; #
      fhir:comment [ fhir:v "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."] ; #
      fhir:system [ fhir:v false] ; #
      fhir:type [ fhir:v true] ; #
      fhir:instance [ fhir:v false] ; #
      fhir:parameter ( [
    fhir:name [ fhir:v "MembersToMatch" ] ;
    fhir:use [ fhir:v "in" ] ;
    fhir:min [ fhir:v 1 ] ;
    fhir:max [ fhir:v "*" ] ;
    fhir:documentation [ fhir:v "Contains one or more members with patient demographics and coverage information to be matched against the payer's member records." ] ;
    fhir:type [ fhir:v "Parameters" ] ;
        ( fhir:part [
    fhir:name [ fhir:v "MemberPatient" ] ;
    fhir:use [ fhir:v "in" ] ;
    fhir:min [ fhir:v 1 ] ;
    fhir:max [ fhir:v "1" ] ;
    fhir:documentation [ fhir:v "The patient demographics for a member to be matched." ] ;
    fhir:type [ fhir:v "Patient" ] ;
          ( fhir:targetProfile [
    fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics>       ] )     ] [
    fhir:name [ fhir:v "CoverageToMatch" ] ;
    fhir:use [ fhir:v "in" ] ;
    fhir:min [ fhir:v 1 ] ;
    fhir:max [ fhir:v "1" ] ;
    fhir:documentation [ fhir:v "The member's existing or previous coverage information to match against." ] ;
    fhir:type [ fhir:v "Coverage" ] ;
          ( fhir:targetProfile [
    fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage>       ] )     ] [
    fhir:name [ fhir:v "CoverageToLink" ] ;
    fhir:use [ fhir:v "in" ] ;
    fhir:min [ fhir:v 0 ] ;
    fhir:max [ fhir:v "1" ] ;
    fhir:documentation [ fhir:v "Optional: The member's new coverage information to link to (e.g., during plan transitions)." ] ;
    fhir:type [ fhir:v "Coverage" ] ;
          ( fhir:targetProfile [
    fhir:v "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage>       ] )     ] [
    fhir:name [ fhir:v "TreatmentAttestation" ] ;
    fhir:use [ fhir:v "in" ] ;
    fhir:min [ fhir:v 1 ] ;
    fhir:max [ fhir:v "1" ] ;
    fhir:documentation [ fhir:v "Provider's attestation to an active treatment relationship with the patient. This replaces the general consent with a specific treatment relationship attestation." ] ;
    fhir:type [ fhir:v "Consent" ] ;
          ( fhir:targetProfile [
    fhir:v "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent>       ] )     ] )
      ] [
    fhir:name [ fhir:v "MatchedMembers" ] ;
    fhir:use [ fhir:v "out" ] ;
    fhir:min [ fhir:v 0 ] ;
    fhir:max [ fhir:v "1" ] ;
    fhir:documentation [ fhir:v "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." ] ;
    fhir:type [ fhir:v "Group" ] ;
        ( fhir:targetProfile [
    fhir:v "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/member-provider-treatment-relationship-group"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/member-provider-treatment-relationship-group>     ] )
      ] [
    fhir:name [ fhir:v "NonMatchedMembers" ] ;
    fhir:use [ fhir:v "out" ] ;
    fhir:min [ fhir:v 0 ] ;
    fhir:max [ fhir:v "1" ] ;
    fhir:documentation [ fhir:v "A Group resource containing members for whom no match could be found in the payer's member records." ] ;
    fhir:type [ fhir:v "Group" ] ;
        ( fhir:targetProfile [
    fhir:v "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-no-match-group"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-no-match-group>     ] )
      ] [
    fhir:name [ fhir:v "TreatmentAttestationConstrainedMembers" ] ;
    fhir:use [ fhir:v "out" ] ;
    fhir:min [ fhir:v 0 ] ;
    fhir:max [ fhir:v "1" ] ;
    fhir:documentation [ fhir:v "A Group resource containing members for whom the provider's treatment attestation could not be verified or does not meet the payer's requirements." ] ;
    fhir:type [ fhir:v "Group" ] ;
        ( fhir:targetProfile [
    fhir:v "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-no-match-group"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-no-match-group>     ] )
      ] [
    fhir:name [ fhir:v "OptOutConstrainedMembers" ] ;
    fhir:use [ fhir:v "out" ] ;
    fhir:min [ fhir:v 0 ] ;
    fhir:max [ fhir:v "1" ] ;
    fhir:documentation [ fhir:v "A Group resource containing members who have opted out of data sharing with providers or this specific provider." ] ;
    fhir:type [ fhir:v "Group" ] ;
        ( fhir:targetProfile [
    fhir:v "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/member-opt-out-group"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/member-opt-out-group>     ] )
      ] ) . #