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 Request Example - TTL Representation

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix loinc: <https://loinc.org/rdf/> .
    @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-request-001"] ; #
      fhir:parameter ( [
    fhir:name [ fhir:v "MembersToMatch" ] ;
        ( fhir:part [
    fhir:name [ fhir:v "MemberPatient" ] ;
          ( fhir:Parameters.parameter.resource [
    a fhir:Patient ;
    fhir:id [ fhir:v "patient-prov-001" ] ;
            ( fhir:identifier [
    fhir:type [
                ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203>               ] ;
    fhir:code [ fhir:v "MB" ]             ] )           ] ;
    fhir:system [
    fhir:v "http://example.org/provider-org/patient-ids"^^xsd:anyURI ;
    fhir:l <http://example.org/provider-org/patient-ids>           ] ;
    fhir:value [ fhir:v "PAT-001" ] ;
    fhir:assigner [
    fhir:display [ fhir:v "Provider Organization" ]           ]         ] ) ;
            ( fhir:name [
    fhir:use [ fhir:v "official" ] ;
    fhir:family [ fhir:v "Johnson" ] ;
              ( fhir:given [ fhir:v "Robert" ] [ fhir:v "Michael" ] )         ] ) ;
            ( fhir:telecom [
    fhir:system [ fhir:v "phone" ] ;
    fhir:value [ fhir:v "555-123-4567" ]         ] ) ;
    fhir:gender [ fhir:v "male" ] ;
    fhir:birthDate [ fhir:v "1965-08-15"^^xsd:date ] ;
            ( fhir:address [
    fhir:use [ fhir:v "home" ] ;
              ( fhir:line [ fhir:v "123 Main Street" ] ) ;
    fhir:city [ fhir:v "Springfield" ] ;
    fhir:state [ fhir:v "IL" ] ;
    fhir:postalCode [ fhir:v "62701" ]         ] )       ] )     ] [
    fhir:name [ fhir:v "CoverageToMatch" ] ;
          ( fhir:Parameters.parameter.resource [
    a fhir:Coverage ;
    fhir:id [ fhir:v "coverage-to-match-001" ] ;
    fhir:meta [
              ( fhir:profile [
    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:status [ fhir:v "draft" ] ;
    fhir:type [
              ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActCode>             ] ;
    fhir:code [ fhir:v "EHPLANS" ]           ] )         ] ;
    fhir:subscriber [
    fhir:l fhir:Patient/patient-prov-001 ;
    fhir:reference [ fhir:v "Patient/patient-prov-001" ]         ] ;
    fhir:subscriberId [ fhir:v "12345678" ] ;
    fhir:beneficiary [
    fhir:l fhir:Patient/patient-prov-001 ;
    fhir:reference [ fhir:v "Patient/patient-prov-001" ]         ] ;
    fhir:relationship [
              ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/subscriber-relationship>             ] ;
    fhir:code [ fhir:v "self" ]           ] )         ] ;
    fhir:period [
    fhir:start [ fhir:v "2023-01-01"^^xsd:date ] ;
    fhir:end [ fhir:v "2023-12-31"^^xsd:date ]         ] ;
            ( fhir:payor [
    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 "9876543210" ]           ] ;
    fhir:display [ fhir:v "Previous Health Plan" ]         ] ) ;
            ( fhir:class [
    fhir:type [
                ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class>               ] ;
    fhir:code [ fhir:v "group" ]             ] )           ] ;
    fhir:value [ fhir:v "EMPLOY-12345" ]         ] [
    fhir:type [
                ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class>               ] ;
    fhir:code [ fhir:v "plan" ]             ] )           ] ;
    fhir:value [ fhir:v "PPO-GOLD" ]         ] )       ] )     ] [
    fhir:name [ fhir:v "TreatmentAttestation" ] ;
          ( fhir:Parameters.parameter.resource [
    a fhir:Consent ;
    fhir:id [ fhir:v "treatment-attestation-001" ] ;
    fhir:meta [
              ( fhir:profile [
    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:status [ fhir:v "active" ] ;
    fhir:scope [
              ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/consentscope"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/consentscope>             ] ;
    fhir:code [ fhir:v "treatment" ]           ] )         ] ;
            ( fhir:category [
              ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/consentcategorycodes"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/consentcategorycodes>             ] ;
    fhir:code [ fhir:v "treat" ] ;
    fhir:display [ fhir:v "Treatment" ]           ] )         ] [
              ( fhir:coding [
    a loinc:64292-6 ;
    fhir:system [
    fhir:v "http://loinc.org"^^xsd:anyURI ;
    fhir:l <http://loinc.org>             ] ;
    fhir:code [ fhir:v "64292-6" ] ;
    fhir:display [ fhir:v "Release of information consent" ]           ] )         ] ) ;
    fhir:patient [
    fhir:l fhir:Patient/patient-prov-001 ;
    fhir:reference [ fhir:v "Patient/patient-prov-001" ]         ] ;
    fhir:dateTime [ fhir:v "2024-12-10T14:30:00Z"^^xsd:dateTime ] ;
            ( fhir:performer [
    fhir:l fhir:Practitioner/provider-001 ;
    fhir:reference [ fhir:v "Practitioner/provider-001" ] ;
    fhir:display [ fhir:v "Dr. Susan Smith, MD" ]         ] ) ;
            ( fhir:organization [
    fhir:l fhir:Organization/provider-org-001 ;
    fhir:reference [ fhir:v "Organization/provider-org-001" ] ;
    fhir:display [ fhir:v "Springfield Medical Center" ]         ] ) ;
    fhir:source [
    a fhir:Reference ;
    fhir:l fhir:DocumentReference/treatment-attestation-form-001 ;
    fhir:reference [ fhir:v "DocumentReference/treatment-attestation-form-001" ] ;
    fhir:display [ fhir:v "Provider Attestation Form" ]         ] ;
            ( fhir:policy [
    fhir:authority [
    fhir:v "https://example.org/compliance"^^xsd:anyURI ;
    fhir:l <https://example.org/compliance>           ] ;
    fhir:uri [
    fhir:v "https://example.org/provider-attestation-policy"^^xsd:anyURI ;
    fhir:l <https://example.org/provider-attestation-policy>           ]         ] ) ;
    fhir:provision [
    fhir:type [ fhir:v "permit" ] ;
    fhir:period [
    fhir:start [ fhir:v "2024-01-15"^^xsd:date ]           ] ;
              ( fhir:actor [
    fhir:role [
                  ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/v3-ParticipationType"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/v3-ParticipationType>                 ] ;
    fhir:code [ fhir:v "IRCP" ] ;
    fhir:display [ fhir:v "information recipient" ]               ] )             ] ;
    fhir:reference [
    fhir:l fhir:Practitioner/provider-001 ;
    fhir:reference [ fhir:v "Practitioner/provider-001" ] ;
    fhir:display [ fhir:v "Dr. Susan Smith" ]             ]           ] ) ;
              ( fhir:purpose [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActReason"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActReason>             ] ;
    fhir:code [ fhir:v "TREATMENT" ] ;
    fhir:display [ fhir:v "Treatment" ]           ] )         ]       ] )     ] [
    fhir:name [ fhir:v "CoverageToLink" ] ;
          ( fhir:Parameters.parameter.resource [
    a fhir:Coverage ;
    fhir:id [ fhir:v "coverage-link-001" ] ;
    fhir:meta [
              ( fhir:profile [
    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:status [ fhir:v "draft" ] ;
    fhir:type [
              ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActCode>             ] ;
    fhir:code [ fhir:v "EHPLANS" ]           ] )         ] ;
    fhir:subscriber [
    fhir:l fhir:Patient/patient-prov-001 ;
    fhir:reference [ fhir:v "Patient/patient-prov-001" ]         ] ;
    fhir:subscriberId [ fhir:v "NEW-12345678" ] ;
    fhir:beneficiary [
    fhir:l fhir:Patient/patient-prov-001 ;
    fhir:reference [ fhir:v "Patient/patient-prov-001" ]         ] ;
    fhir:relationship [
              ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/subscriber-relationship>             ] ;
    fhir:code [ fhir:v "self" ]           ] )         ] ;
    fhir:period [
    fhir:start [ fhir:v "2024-01-01"^^xsd:date ] ;
    fhir:end [ fhir:v "2024-12-31"^^xsd:date ]         ] ;
            ( fhir:payor [
    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:class [
    fhir:type [
                ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class>               ] ;
    fhir:code [ fhir:v "group" ]             ] )           ] ;
    fhir:value [ fhir:v "EMPLOY-NEW" ]         ] [
    fhir:type [
                ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class>               ] ;
    fhir:code [ fhir:v "plan" ]             ] )           ] ;
    fhir:value [ fhir:v "PPO-PREMIUM" ]         ] )       ] )     ] )
      ] [
    fhir:name [ fhir:v "MembersToMatch" ] ;
        ( fhir:part [
    fhir:name [ fhir:v "MemberPatient" ] ;
          ( fhir:Parameters.parameter.resource [
    a fhir:Patient ;
    fhir:id [ fhir:v "patient-prov-002" ] ;
            ( fhir:identifier [
    fhir:type [
                ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203>               ] ;
    fhir:code [ fhir:v "MB" ]             ] )           ] ;
    fhir:system [
    fhir:v "http://example.org/provider-org/patient-ids"^^xsd:anyURI ;
    fhir:l <http://example.org/provider-org/patient-ids>           ] ;
    fhir:value [ fhir:v "PAT-002" ] ;
    fhir:assigner [
    fhir:display [ fhir:v "Provider Organization" ]           ]         ] ) ;
            ( fhir:name [
    fhir:use [ fhir:v "official" ] ;
    fhir:family [ fhir:v "Williams" ] ;
              ( fhir:given [ fhir:v "Sarah" ] [ fhir:v "Elizabeth" ] )         ] ) ;
            ( fhir:telecom [
    fhir:system [ fhir:v "phone" ] ;
    fhir:value [ fhir:v "555-987-6543" ]         ] ) ;
    fhir:gender [ fhir:v "female" ] ;
    fhir:birthDate [ fhir:v "1978-03-22"^^xsd:date ] ;
            ( fhir:address [
    fhir:use [ fhir:v "home" ] ;
              ( fhir:line [ fhir:v "456 Oak Avenue" ] ) ;
    fhir:city [ fhir:v "Columbus" ] ;
    fhir:state [ fhir:v "OH" ] ;
    fhir:postalCode [ fhir:v "43085" ]         ] )       ] )     ] [
    fhir:name [ fhir:v "CoverageToMatch" ] ;
          ( fhir:Parameters.parameter.resource [
    a fhir:Coverage ;
    fhir:id [ fhir:v "coverage-to-match-002" ] ;
    fhir:meta [
              ( fhir:profile [
    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:status [ fhir:v "draft" ] ;
    fhir:type [
              ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActCode"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActCode>             ] ;
    fhir:code [ fhir:v "EHPLANS" ]           ] )         ] ;
    fhir:subscriber [
    fhir:l fhir:Patient/patient-prov-002 ;
    fhir:reference [ fhir:v "Patient/patient-prov-002" ]         ] ;
    fhir:subscriberId [ fhir:v "87654321" ] ;
    fhir:beneficiary [
    fhir:l fhir:Patient/patient-prov-002 ;
    fhir:reference [ fhir:v "Patient/patient-prov-002" ]         ] ;
    fhir:relationship [
              ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/subscriber-relationship"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/subscriber-relationship>             ] ;
    fhir:code [ fhir:v "self" ]           ] )         ] ;
    fhir:period [
    fhir:start [ fhir:v "2023-06-01"^^xsd:date ] ;
    fhir:end [ fhir:v "2024-05-31"^^xsd:date ]         ] ;
            ( fhir:payor [
    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 "1111111111" ]           ] ;
    fhir:display [ fhir:v "Another Health Plan" ]         ] ) ;
            ( fhir:class [
    fhir:type [
                ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class>               ] ;
    fhir:code [ fhir:v "group" ]             ] )           ] ;
    fhir:value [ fhir:v "EMPLOY-67890" ]         ] [
    fhir:type [
                ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/coverage-class"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/coverage-class>               ] ;
    fhir:code [ fhir:v "plan" ]             ] )           ] ;
    fhir:value [ fhir:v "HMO-BASIC" ]         ] )       ] )     ] [
    fhir:name [ fhir:v "TreatmentAttestation" ] ;
          ( fhir:Parameters.parameter.resource [
    a fhir:Consent ;
    fhir:id [ fhir:v "treatment-attestation-002" ] ;
    fhir:meta [
              ( fhir:profile [
    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:status [ fhir:v "active" ] ;
    fhir:scope [
              ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/consentscope"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/consentscope>             ] ;
    fhir:code [ fhir:v "treatment" ]           ] )         ] ;
            ( fhir:category [
              ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/consentcategorycodes"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/consentcategorycodes>             ] ;
    fhir:code [ fhir:v "treat" ] ;
    fhir:display [ fhir:v "Treatment" ]           ] )         ] [
              ( fhir:coding [
    a loinc:64292-6 ;
    fhir:system [
    fhir:v "http://loinc.org"^^xsd:anyURI ;
    fhir:l <http://loinc.org>             ] ;
    fhir:code [ fhir:v "64292-6" ] ;
    fhir:display [ fhir:v "Release of information consent" ]           ] )         ] ) ;
    fhir:patient [
    fhir:l fhir:Patient/patient-prov-002 ;
    fhir:reference [ fhir:v "Patient/patient-prov-002" ]         ] ;
    fhir:dateTime [ fhir:v "2024-12-09T10:15:00Z"^^xsd:dateTime ] ;
            ( fhir:performer [
    fhir:l fhir:Practitioner/provider-002 ;
    fhir:reference [ fhir:v "Practitioner/provider-002" ] ;
    fhir:display [ fhir:v "Dr. James Brown, MD" ]         ] ) ;
            ( fhir:organization [
    fhir:l fhir:Organization/provider-org-002 ;
    fhir:reference [ fhir:v "Organization/provider-org-002" ] ;
    fhir:display [ fhir:v "Columbus Clinic" ]         ] ) ;
    fhir:source [
    a fhir:Reference ;
    fhir:l fhir:DocumentReference/treatment-attestation-form-002 ;
    fhir:reference [ fhir:v "DocumentReference/treatment-attestation-form-002" ] ;
    fhir:display [ fhir:v "Provider Attestation Form" ]         ] ;
            ( fhir:policy [
    fhir:uri [
    fhir:v "https://example.org/provider-attestation-policy"^^xsd:anyURI ;
    fhir:l <https://example.org/provider-attestation-policy>           ]         ] ) ;
    fhir:provision [
    fhir:type [ fhir:v "permit" ] ;
    fhir:period [
    fhir:start [ fhir:v "2024-02-01"^^xsd:date ]           ] ;
              ( fhir:actor [
    fhir:role [
                  ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/v3-ParticipationType"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/v3-ParticipationType>                 ] ;
    fhir:code [ fhir:v "IRCP" ] ;
    fhir:display [ fhir:v "information recipient" ]               ] )             ] ;
    fhir:reference [
    fhir:l fhir:Practitioner/provider-002 ;
    fhir:reference [ fhir:v "Practitioner/provider-002" ] ;
    fhir:display [ fhir:v "Dr. James Brown" ]             ]           ] ) ;
              ( fhir:purpose [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/v3-ActReason"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/v3-ActReason>             ] ;
    fhir:code [ fhir:v "TREATMENT" ] ;
    fhir:display [ fhir:v "Treatment" ]           ] )         ]       ] )     ] )
      ] ) . #