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 - JSON Representation

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    {
      "resourceType" : "Parameters",
      "id" : "provider-member-match-request-001",
      "parameter" : [
        {
          "name" : "MembersToMatch",
          "part" : [
            {
              "name" : "MemberPatient",
              "resource" : {
                "resourceType" : "Patient",
                "id" : "patient-prov-001",
                "identifier" : [
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code" : "MB"
                        }
                      ]
                    },
                    "system" : "http://example.org/provider-org/patient-ids",
                    "value" : "PAT-001",
                    "assigner" : {
                      "display" : "Provider Organization"
                    }
                  }
                ],
                "name" : [
                  {
                    "use" : "official",
                    "family" : "Johnson",
                    "given" : [
                      "Robert",
                      "Michael"
                    ]
                  }
                ],
                "telecom" : [
                  {
                    "system" : "phone",
                    "value" : "555-123-4567"
                  }
                ],
                "gender" : "male",
                "birthDate" : "1965-08-15",
                "address" : [
                  {
                    "use" : "home",
                    "line" : [
                      "123 Main Street"
                    ],
                    "city" : "Springfield",
                    "state" : "IL",
                    "postalCode" : "62701"
                  }
                ]
              }
            },
            {
              "name" : "CoverageToMatch",
              "resource" : {
                "resourceType" : "Coverage",
                "id" : "coverage-to-match-001",
                "meta" : {
                  "profile" : [
                    🔗 "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"
                  ]
                },
                "status" : "draft",
                "type" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                      "code" : "EHPLANS"
                    }
                  ]
                },
                "subscriber" : {
                  "reference" : "Patient/patient-prov-001"
                },
                "subscriberId" : "12345678",
                "beneficiary" : {
                  "reference" : "Patient/patient-prov-001"
                },
                "relationship" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                      "code" : "self"
                    }
                  ]
                },
                "period" : {
                  "start" : "2023-01-01",
                  "end" : "2023-12-31"
                },
                "payor" : [
                  {
                    "identifier" : {
                      "system" : "http://hl7.org/fhir/sid/us-npi",
                      "value" : "9876543210"
                    },
                    "display" : "Previous Health Plan"
                  }
                ],
                "class" : [
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                          "code" : "group"
                        }
                      ]
                    },
                    "value" : "EMPLOY-12345"
                  },
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                          "code" : "plan"
                        }
                      ]
                    },
                    "value" : "PPO-GOLD"
                  }
                ]
              }
            },
            {
              "name" : "TreatmentAttestation",
              "resource" : {
                "resourceType" : "Consent",
                "id" : "treatment-attestation-001",
                "meta" : {
                  "profile" : [
                    🔗 "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent"
                  ]
                },
                "status" : "active",
                "scope" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/consentscope",
                      "code" : "treatment"
                    }
                  ]
                },
                "category" : [
                  {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/consentcategorycodes",
                        "code" : "treat",
                        "display" : "Treatment"
                      }
                    ]
                  },
                  {
                    "coding" : [
                      {
                        "system" : "http://loinc.org",
                        "code" : "64292-6",
                        "display" : "Release of information consent"
                      }
                    ]
                  }
                ],
                "patient" : {
                  "reference" : "Patient/patient-prov-001"
                },
                "dateTime" : "2024-12-10T14:30:00Z",
                "performer" : [
                  {
                    "reference" : "Practitioner/provider-001",
                    "display" : "Dr. Susan Smith, MD"
                  }
                ],
                "organization" : [
                  {
                    "reference" : "Organization/provider-org-001",
                    "display" : "Springfield Medical Center"
                  }
                ],
                "sourceReference" : {
                  "reference" : "DocumentReference/treatment-attestation-form-001",
                  "display" : "Provider Attestation Form"
                },
                "policy" : [
                  {
                    "authority" : "https://example.org/compliance",
                    "uri" : "https://example.org/provider-attestation-policy"
                  }
                ],
                "provision" : {
                  "type" : "permit",
                  "period" : {
                    "start" : "2024-01-15"
                  },
                  "actor" : [
                    {
                      "role" : {
                        "coding" : [
                          {
                            "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                            "code" : "IRCP",
                            "display" : "information recipient"
                          }
                        ]
                      },
                      "reference" : {
                        "reference" : "Practitioner/provider-001",
                        "display" : "Dr. Susan Smith"
                      }
                    }
                  ],
                  "purpose" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                      "code" : "TREATMENT",
                      "display" : "Treatment"
                    }
                  ]
                }
              }
            },
            {
              "name" : "CoverageToLink",
              "resource" : {
                "resourceType" : "Coverage",
                "id" : "coverage-link-001",
                "meta" : {
                  "profile" : [
                    🔗 "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"
                  ]
                },
                "status" : "draft",
                "type" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                      "code" : "EHPLANS"
                    }
                  ]
                },
                "subscriber" : {
                  "reference" : "Patient/patient-prov-001"
                },
                "subscriberId" : "NEW-12345678",
                "beneficiary" : {
                  "reference" : "Patient/patient-prov-001"
                },
                "relationship" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                      "code" : "self"
                    }
                  ]
                },
                "period" : {
                  "start" : "2024-01-01",
                  "end" : "2024-12-31"
                },
                "payor" : [
                  {
                    "identifier" : {
                      "system" : "http://hl7.org/fhir/sid/us-npi",
                      "value" : "5555555555"
                    },
                    "display" : "Current Payer"
                  }
                ],
                "class" : [
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                          "code" : "group"
                        }
                      ]
                    },
                    "value" : "EMPLOY-NEW"
                  },
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                          "code" : "plan"
                        }
                      ]
                    },
                    "value" : "PPO-PREMIUM"
                  }
                ]
              }
            }
          ]
        },
        {
          "name" : "MembersToMatch",
          "part" : [
            {
              "name" : "MemberPatient",
              "resource" : {
                "resourceType" : "Patient",
                "id" : "patient-prov-002",
                "identifier" : [
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                          "code" : "MB"
                        }
                      ]
                    },
                    "system" : "http://example.org/provider-org/patient-ids",
                    "value" : "PAT-002",
                    "assigner" : {
                      "display" : "Provider Organization"
                    }
                  }
                ],
                "name" : [
                  {
                    "use" : "official",
                    "family" : "Williams",
                    "given" : [
                      "Sarah",
                      "Elizabeth"
                    ]
                  }
                ],
                "telecom" : [
                  {
                    "system" : "phone",
                    "value" : "555-987-6543"
                  }
                ],
                "gender" : "female",
                "birthDate" : "1978-03-22",
                "address" : [
                  {
                    "use" : "home",
                    "line" : [
                      "456 Oak Avenue"
                    ],
                    "city" : "Columbus",
                    "state" : "OH",
                    "postalCode" : "43085"
                  }
                ]
              }
            },
            {
              "name" : "CoverageToMatch",
              "resource" : {
                "resourceType" : "Coverage",
                "id" : "coverage-to-match-002",
                "meta" : {
                  "profile" : [
                    🔗 "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"
                  ]
                },
                "status" : "draft",
                "type" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                      "code" : "EHPLANS"
                    }
                  ]
                },
                "subscriber" : {
                  "reference" : "Patient/patient-prov-002"
                },
                "subscriberId" : "87654321",
                "beneficiary" : {
                  "reference" : "Patient/patient-prov-002"
                },
                "relationship" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
                      "code" : "self"
                    }
                  ]
                },
                "period" : {
                  "start" : "2023-06-01",
                  "end" : "2024-05-31"
                },
                "payor" : [
                  {
                    "identifier" : {
                      "system" : "http://hl7.org/fhir/sid/us-npi",
                      "value" : "1111111111"
                    },
                    "display" : "Another Health Plan"
                  }
                ],
                "class" : [
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                          "code" : "group"
                        }
                      ]
                    },
                    "value" : "EMPLOY-67890"
                  },
                  {
                    "type" : {
                      "coding" : [
                        {
                          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
                          "code" : "plan"
                        }
                      ]
                    },
                    "value" : "HMO-BASIC"
                  }
                ]
              }
            },
            {
              "name" : "TreatmentAttestation",
              "resource" : {
                "resourceType" : "Consent",
                "id" : "treatment-attestation-002",
                "meta" : {
                  "profile" : [
                    🔗 "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent"
                  ]
                },
                "status" : "active",
                "scope" : {
                  "coding" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/consentscope",
                      "code" : "treatment"
                    }
                  ]
                },
                "category" : [
                  {
                    "coding" : [
                      {
                        "system" : "http://terminology.hl7.org/CodeSystem/consentcategorycodes",
                        "code" : "treat",
                        "display" : "Treatment"
                      }
                    ]
                  },
                  {
                    "coding" : [
                      {
                        "system" : "http://loinc.org",
                        "code" : "64292-6",
                        "display" : "Release of information consent"
                      }
                    ]
                  }
                ],
                "patient" : {
                  "reference" : "Patient/patient-prov-002"
                },
                "dateTime" : "2024-12-09T10:15:00Z",
                "performer" : [
                  {
                    "reference" : "Practitioner/provider-002",
                    "display" : "Dr. James Brown, MD"
                  }
                ],
                "organization" : [
                  {
                    "reference" : "Organization/provider-org-002",
                    "display" : "Columbus Clinic"
                  }
                ],
                "sourceReference" : {
                  "reference" : "DocumentReference/treatment-attestation-form-002",
                  "display" : "Provider Attestation Form"
                },
                "policy" : [
                  {
                    "uri" : "https://example.org/provider-attestation-policy"
                  }
                ],
                "provision" : {
                  "type" : "permit",
                  "period" : {
                    "start" : "2024-02-01"
                  },
                  "actor" : [
                    {
                      "role" : {
                        "coding" : [
                          {
                            "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                            "code" : "IRCP",
                            "display" : "information recipient"
                          }
                        ]
                      },
                      "reference" : {
                        "reference" : "Practitioner/provider-002",
                        "display" : "Dr. James Brown"
                      }
                    }
                  ],
                  "purpose" : [
                    {
                      "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                      "code" : "TREATMENT",
                      "display" : "Treatment"
                    }
                  ]
                }
              }
            }
          ]
        }
      ]
    }