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 - TTL Representation

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