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

## : Provenance Payer Data Source Format - JSON Representation

Page standards status: Trial-use | Maturity Level: 2

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    {
      "resourceType" : "CodeSystem",
      "id" : "ProvenancePayerDataSource",
      "text" : {
        "status" : "generated",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem ProvenancePayerDataSource</b></p><a name=\"ProvenancePayerDataSource\"> </a><a name=\"hcProvenancePayerDataSource\"> </a><p>This case-insensitive code system <code>http://hl7.org/fhir/us/davinci-pdex/CodeSystem/ProvenancePayerDataSource</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">hl7v2other<a name=\"ProvenancePayerDataSource-hl7v2other\"> </a></td><td>HL7 v2</td><td>HL7 v2 Message</td></tr><tr><td style=\"white-space:nowrap\">hl7v2oru<a name=\"ProvenancePayerDataSource-hl7v2oru\"> </a></td><td>HL7 v2 ORU</td><td>HL7 v2 Structured Observation Report(ORU) message</td></tr><tr><td style=\"white-space:nowrap\">hl7v2adt<a name=\"ProvenancePayerDataSource-hl7v2adt\"> </a></td><td>HL7 v2 ADT</td><td>HL7 v2 Admit, Discharge Transfer (ADT) message</td></tr><tr><td style=\"white-space:nowrap\">hl7v2r01<a name=\"ProvenancePayerDataSource-hl7v2r01\"> </a></td><td>HL7 v2 R01</td><td>HL7 v2 Observation (R01) message</td></tr><tr><td style=\"white-space:nowrap\">hl7v2rsp<a name=\"ProvenancePayerDataSource-hl7v2rsp\"> </a></td><td>HL7 v2 RSP</td><td>HL7 V2 Immunization Record Response</td></tr><tr><td style=\"white-space:nowrap\">hl7v2orm<a name=\"ProvenancePayerDataSource-hl7v2orm\"> </a></td><td>HL7 v2 ORM</td><td>HL7 v2 Orders</td></tr><tr><td style=\"white-space:nowrap\">hl7v2mdm<a name=\"ProvenancePayerDataSource-hl7v2mdm\"> </a></td><td>HL7 v2 MDM</td><td>Medical Document Management</td></tr><tr><td style=\"white-space:nowrap\">hl7v2vxu<a name=\"ProvenancePayerDataSource-hl7v2vxu\"> </a></td><td>HL7 v2 VXU</td><td>HL7 V2 Immunization Transaction</td></tr><tr><td style=\"white-space:nowrap\">hl7v3<a name=\"ProvenancePayerDataSource-hl7v3\"> </a></td><td>HL7 v3</td><td>HL7 v3 Message</td></tr><tr><td style=\"white-space:nowrap\">hl7ccda<a name=\"ProvenancePayerDataSource-hl7ccda\"> </a></td><td>HL7 C-CDA</td><td>HL7 Consolidated-Clinical Document Architecture</td></tr><tr><td style=\"white-space:nowrap\">hl7cda<a name=\"ProvenancePayerDataSource-hl7cda\"> </a></td><td>HL7 CDA</td><td>HL7 CDA documents that are not C-CDA</td></tr><tr><td style=\"white-space:nowrap\">hl7cdaqrda<a name=\"ProvenancePayerDataSource-hl7cdaqrda\"> </a></td><td>HL7 CDA QRDA</td><td>HL7 Quality Reporting Document</td></tr><tr><td style=\"white-space:nowrap\">hl7fhirdstu2<a name=\"ProvenancePayerDataSource-hl7fhirdstu2\"> </a></td><td>FHIR DSTU2</td><td>HL7 FHIR DSTU2</td></tr><tr><td style=\"white-space:nowrap\">hl7fhirdstu3<a name=\"ProvenancePayerDataSource-hl7fhirdstu3\"> </a></td><td>FHIR STU3</td><td>HL7 FHIR STU3</td></tr><tr><td style=\"white-space:nowrap\">hl7fhirr4<a name=\"ProvenancePayerDataSource-hl7fhirr4\"> </a></td><td>FHIR R4</td><td>HL7 FHIR R4</td></tr><tr><td style=\"white-space:nowrap\">x12837<a name=\"ProvenancePayerDataSource-x12837\"> </a></td><td>837 claim</td><td>X12 837 Claim</td></tr><tr><td style=\"white-space:nowrap\">x12278<a name=\"ProvenancePayerDataSource-x12278\"> </a></td><td>278</td><td>X12 Prior Authorization</td></tr><tr><td style=\"white-space:nowrap\">x12275<a name=\"ProvenancePayerDataSource-x12275\"> </a></td><td>275</td><td>X12 Attachment</td></tr><tr><td style=\"white-space:nowrap\">x12other<a name=\"ProvenancePayerDataSource-x12other\"> </a></td><td>X12</td><td>X12 non-specific transaction</td></tr><tr><td style=\"white-space:nowrap\">script<a name=\"ProvenancePayerDataSource-script\"> </a></td><td>NCPDP SCRIPT</td><td>National Council for Prescription Drug Programs (NCPDP) SCRIPT message (eRx)</td></tr><tr><td style=\"white-space:nowrap\">ncpdp<a name=\"ProvenancePayerDataSource-ncpdp\"> </a></td><td>NCPDP Telecommunication</td><td>NCPDP Telecommunication transaction (pharmacy claims)</td></tr><tr><td style=\"white-space:nowrap\">capture<a name=\"ProvenancePayerDataSource-capture\"> </a></td><td>Direct Capture</td><td>Direct Capture, such as into a payers case management system</td></tr><tr><td style=\"white-space:nowrap\">customtx<a name=\"ProvenancePayerDataSource-customtx\"> </a></td><td>Trading Partner Format</td><td>Trading Partner Proprietary format</td></tr><tr><td style=\"white-space:nowrap\">image<a name=\"ProvenancePayerDataSource-image\"> </a></td><td>Image</td><td>Fax or scanned document</td></tr><tr><td style=\"white-space:nowrap\">unstructured<a name=\"ProvenancePayerDataSource-unstructured\"> </a></td><td>Unstructured Document</td><td>PDF, text and other unstructured document</td></tr><tr><td style=\"white-space:nowrap\">other<a name=\"ProvenancePayerDataSource-other\"> </a></td><td>Other</td><td>Any other document format not specifically defined</td></tr></table></div>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
          "valueCode" : "fm"
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
          "valueInteger" : 2,
          "_valueInteger" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
                "valueCanonical" : "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"
              }
            ]
          }
        },
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
          "valueCode" : "trial-use",
          "_valueCode" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
                "valueCanonical" : "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"
              }
            ]
          }
        }
      ],
      "url" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/ProvenancePayerDataSource",
      "version" : "2.1.1",
      "name" : "ProvenancePayerDataSource",
      "title" : "Provenance Payer Data Source Format",
      "status" : "active",
      "experimental" : false,
      "date" : "2025-12-18T03:22:36+00:00",
      "publisher" : "HL7 International / Financial Management",
      "contact" : [
        {
          "name" : "HL7 International / Financial Management",
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://www.hl7.org/Special/committees/fm"
            },
            {
              "system" : "email",
              "value" : "fm@lists.HL7.org"
            }
          ]
        },
        {
          "name" : "Mark Scrimshire (mark.scrimshire@onyxhealth.io)",
          "telecom" : [
            {
              "system" : "email",
              "value" : "mailto:mark.scrimshire@onyxhealth.io"
            }
          ]
        },
        {
          "name" : "HL7 International - Financial Management",
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://www.hl7.org/Special/committees/fm"
            }
          ]
        }
      ],
      "description" : "CodeSystem for source formats that identify what non-FHIR source was used to create FHIR record(s)",
      "jurisdiction" : [
        {
          "coding" : [
            {
              "system" : "urn:iso:std:iso:3166",
              "code" : "US",
              "display" : "United States of America"
            }
          ]
        }
      ],
      "copyright" : "Used by permission of HL7 International, all rights reserved Creative Commons License",
      "caseSensitive" : false,
      "content" : "complete",
      "count" : 26,
      "concept" : [
        {
          "code" : "hl7v2other",
          "display" : "HL7 v2",
          "definition" : "HL7 v2 Message"
        },
        {
          "code" : "hl7v2oru",
          "display" : "HL7 v2 ORU",
          "definition" : "HL7 v2 Structured Observation Report(ORU) message"
        },
        {
          "code" : "hl7v2adt",
          "display" : "HL7 v2 ADT",
          "definition" : "HL7 v2 Admit, Discharge Transfer (ADT) message"
        },
        {
          "code" : "hl7v2r01",
          "display" : "HL7 v2 R01",
          "definition" : "HL7 v2 Observation (R01) message"
        },
        {
          "code" : "hl7v2rsp",
          "display" : "HL7 v2 RSP",
          "definition" : "HL7 V2 Immunization Record Response"
        },
        {
          "code" : "hl7v2orm",
          "display" : "HL7 v2 ORM",
          "definition" : "HL7 v2 Orders"
        },
        {
          "code" : "hl7v2mdm",
          "display" : "HL7 v2 MDM",
          "definition" : "Medical Document Management"
        },
        {
          "code" : "hl7v2vxu",
          "display" : "HL7 v2 VXU",
          "definition" : "HL7 V2 Immunization Transaction"
        },
        {
          "code" : "hl7v3",
          "display" : "HL7 v3",
          "definition" : "HL7 v3 Message"
        },
        {
          "code" : "hl7ccda",
          "display" : "HL7 C-CDA",
          "definition" : "HL7 Consolidated-Clinical Document Architecture"
        },
        {
          "code" : "hl7cda",
          "display" : "HL7 CDA",
          "definition" : "HL7 CDA documents that are not C-CDA"
        },
        {
          "code" : "hl7cdaqrda",
          "display" : "HL7 CDA QRDA",
          "definition" : "HL7 Quality Reporting Document"
        },
        {
          "code" : "hl7fhirdstu2",
          "display" : "FHIR DSTU2",
          "definition" : "HL7 FHIR DSTU2"
        },
        {
          "code" : "hl7fhirdstu3",
          "display" : "FHIR STU3",
          "definition" : "HL7 FHIR STU3"
        },
        {
          "code" : "hl7fhirr4",
          "display" : "FHIR R4",
          "definition" : "HL7 FHIR R4"
        },
        {
          "code" : "x12837",
          "display" : "837 claim",
          "definition" : "X12 837 Claim"
        },
        {
          "code" : "x12278",
          "display" : "278",
          "definition" : "X12 Prior Authorization"
        },
        {
          "code" : "x12275",
          "display" : "275",
          "definition" : "X12 Attachment"
        },
        {
          "code" : "x12other",
          "display" : "X12",
          "definition" : "X12 non-specific transaction"
        },
        {
          "code" : "script",
          "display" : "NCPDP SCRIPT",
          "definition" : "National Council for Prescription Drug Programs (NCPDP) SCRIPT message (eRx)"
        },
        {
          "code" : "ncpdp",
          "display" : "NCPDP Telecommunication",
          "definition" : "NCPDP Telecommunication transaction (pharmacy claims)"
        },
        {
          "code" : "capture",
          "display" : "Direct Capture",
          "definition" : "Direct Capture, such as into a payers case management system"
        },
        {
          "code" : "customtx",
          "display" : "Trading Partner Format",
          "definition" : "Trading Partner Proprietary format"
        },
        {
          "code" : "image",
          "display" : "Image",
          "definition" : "Fax or scanned document"
        },
        {
          "code" : "unstructured",
          "display" : "Unstructured Document",
          "definition" : "PDF, text and other unstructured document"
        },
        {
          "code" : "other",
          "display" : "Other",
          "definition" : "Any other document format not specifically defined"
        }
      ]
    }