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 - XML Representation

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