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

## OperationDefinition: PDex Provider-Member-Match Operation (Experimental)

Official URL: http://hl7.org/fhir/us/davinci-pdex/OperationDefinition/ProviderMemberMatch | Version: 2.1.1
Standards status: Informative | Computable Name: ProviderMemberMatch
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

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.

### Parameters

Use | Name | Scope | Cardinality | Type | Binding | Documentation
IN | MembersToMatch |  | 1..* | Parameters |  | Contains one or more members with patient demographics and coverage information to be matched against the payer's member records.
OUT | MatchedMembers |  | 0..1 | Group (Member-Provider Treatment Relationship Group) |  | 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.
OUT | NonMatchedMembers |  | 0..1 | Group (PDex Member No Match Group) |  | A Group resource containing members for whom no match could be found in the payer's member records.
OUT | TreatmentAttestationConstrainedMembers |  | 0..1 | Group (PDex Member No Match Group) |  | A Group resource containing members for whom the provider's treatment attestation could not be verified or does not meet the payer's requirements.
OUT | OptOutConstrainedMembers |  | 0..1 | Group (Member Opt-Out Group) |  | A Group resource containing members who have opted out of data sharing with providers or this specific provider.

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.