Da Vinci Payer Data Exchange
2.1.1 - STU 2.1
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
| Official URL: http://hl7.org/fhir/us/davinci-pdex/OperationDefinition/ProviderMemberMatch | Version: 2.1.1 | |||
| Standards status: Informative | Computable Name: ProviderMemberMatch | |||
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License |
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Provider-Member-Match Operation enables providers to match patient demographics and coverage information against a payer's member records. The operation returns matched members as a Group resource that can be used with the $davinci-data-export operation for bulk data retrieval. This operation aligns with the Payer-to-Payer Bulk Member Match but is designed for provider-initiated requests.
The matched members returned in the MatchedMembers Group can be used directly with the $davinci-data-export operation on the Group resource to retrieve bulk FHIR data for all matched members. The $davinci-data-export operation will return a manifest file referencing the bulk data files containing the member health information in ndjson format.
| Use | Name | Scope | Cardinality | Type | Binding | Documentation |
| IN | MembersToMatch | 1..* | Parameters | Contains one or more members with patient demographics and coverage information to be matched against the payer's member records. | ||
| OUT | MatchedMembers | 0..1 | Group (Member-Provider Treatment Relationship Group) | A Group resource containing members successfully matched and for whom a treatment relationship has been confirmed. This Group can be used with the $davinci-data-export operation to retrieve bulk data. | ||
| OUT | NonMatchedMembers | 0..1 | Group (PDex Member No Match Group) | A Group resource containing members for whom no match could be found in the payer's member records. | ||
| OUT | TreatmentAttestationConstrainedMembers | 0..1 | Group (PDex Member No Match Group) | A Group resource containing members for whom the provider's treatment attestation could not be verified or does not meet the payer's requirements. | ||
| OUT | OptOutConstrainedMembers | 0..1 | Group (Member Opt-Out Group) | A Group resource containing members who have opted out of data sharing with providers or this specific provider. |
The Group resources returned by this operation can be used as input to the $davinci-data-export operation to perform bulk member matching and retrieve the associated bulk member health history data.
IG © 2024+ HL7 International / Financial Management. Package hl7.fhir.us.davinci-pdex#2.1.1 based on FHIR 4.0.1. Generated 2025-12-18
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