Da Vinci Payer Data Exchange
2.1.1 - STU 2.1 United States of America flag

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

Resource Profile: Provider Member No Match Group ( Experimental )

Official URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-member-no-match-group Version: 2.1.1
Standards status: Informative Computable Name: ProviderMemberNoMatchGroup

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

A Group List created by the Payer to provide information back to a requesting provider about failed matches. Based on the Group resource. An Extension is added to capture the submitted patient demographics from the provider's request. The match may have failed for one of two reasons: a) No match on member (member not found in payer's system), or b) Matched but unable to comply due to member's opt-out of Provider Access API.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Group C 0..* Group Group of multiple entities
Constraints: grp-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Submitted member demographics from provider
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... type Σ 1..1 code Group of persons (patients)
Binding: GroupType (required): Types of resources that are part of group.
Required Pattern: person
... actual ΣC 1..1 boolean Actual group (not definitional)
Required Pattern: true
... code SΣ 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
... managingEntity SΣ 1..1 Reference(Organization | RelatedPerson | Practitioner | PractitionerRole) Payer managing this group
... member SC 1..* BackboneElement Non-matched or consent-constrained members
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... entity S 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
..... Slices for extension Content/Rules for all slices
...... extension:nonMatchedMember S 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Group.type Base required GroupType 📍4.0.1 FHIR Std.
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.1.1 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error Group If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Group If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Group If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Group If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Group A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
grp-1 error Group Can only have members if group is "actual" member.empty() or (actual = true)

This structure is derived from Group

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Group 0..* Group Group of multiple entities
... contained 0..* Resource Submitted member demographics from provider
... identifier S 0..* Identifier Provider organization identifier
... type 1..1 code Group of persons (patients)
Required Pattern: person
... code S 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
... managingEntity S 1..1 Reference(Organization | RelatedPerson | Practitioner | PractitionerRole) Payer managing this group
... member S 1..* BackboneElement Non-matched or consent-constrained members
.... entity S 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
..... Slices for extension Content/Rules for all slices
...... extension:nonMatchedMember S 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.1.1 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Group C 0..* Group Group of multiple entities
Constraints: grp-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Submitted member demographics from provider
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..* Identifier Provider organization identifier
... active Σ 0..1 boolean Whether this group's record is in active use
... type Σ 1..1 code Group of persons (patients)
Binding: GroupType (required): Types of resources that are part of group.
Required Pattern: person
... actual ΣC 1..1 boolean Actual group (not definitional)
Required Pattern: true
... code SΣ 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
... name Σ 0..1 string Label for Group
... quantity Σ 0..1 unsignedInt Number of members
... managingEntity SΣ 1..1 Reference(Organization | RelatedPerson | Practitioner | PractitionerRole) Payer managing this group
... characteristic 0..* BackboneElement Include / Exclude group members by Trait
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code 1..1 CodeableConcept Kind of characteristic
Binding Description: (example): List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.
.... value[x] 1..1 Value held by characteristic
Binding Description: (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.
..... valueCodeableConcept CodeableConcept
..... valueBoolean boolean
..... valueQuantity Quantity
..... valueRange Range
..... valueReference Reference(Any)
.... exclude 1..1 boolean Group includes or excludes
.... period 0..1 Period Period over which characteristic is tested
... member SC 1..* BackboneElement Non-matched or consent-constrained members
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... entity S 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... extension:nonMatchedMember S 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
..... display Σ 0..1 string Text alternative for the resource
.... period 0..1 Period Period member belonged to the group
.... inactive 0..1 boolean If member is no longer in group

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Group.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Group.type Base required GroupType 📍4.0.1 FHIR Std.
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.1.1 This IG
Group.characteristic.​code Base example Not State Unknown
Group.characteristic.​value[x] Base example Not State Unknown
Group.member.entity.​type Base extensible ResourceType 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Group If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Group If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Group If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Group If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Group A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
grp-1 error Group Can only have members if group is "actual" member.empty() or (actual = true)

This structure is derived from Group

Summary

Mandatory: 3 elements
Must-Support: 6 elements

Extensions

This structure refers to these extensions:

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Group C 0..* Group Group of multiple entities
Constraints: grp-1
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... contained 0..* Resource Submitted member demographics from provider
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... type Σ 1..1 code Group of persons (patients)
Binding: GroupType (required): Types of resources that are part of group.
Required Pattern: person
... actual ΣC 1..1 boolean Actual group (not definitional)
Required Pattern: true
... code SΣ 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
... managingEntity SΣ 1..1 Reference(Organization | RelatedPerson | Practitioner | PractitionerRole) Payer managing this group
... member SC 1..* BackboneElement Non-matched or consent-constrained members
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... entity S 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
..... Slices for extension Content/Rules for all slices
...... extension:nonMatchedMember S 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Group.type Base required GroupType 📍4.0.1 FHIR Std.
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.1.1 This IG

Constraints

Id Grade Path(s) Description Expression
dom-2 error Group If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Group If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Group If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Group If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Group A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
grp-1 error Group Can only have members if group is "actual" member.empty() or (actual = true)

Differential View

This structure is derived from Group

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Group 0..* Group Group of multiple entities
... contained 0..* Resource Submitted member demographics from provider
... identifier S 0..* Identifier Provider organization identifier
... type 1..1 code Group of persons (patients)
Required Pattern: person
... code S 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
... managingEntity S 1..1 Reference(Organization | RelatedPerson | Practitioner | PractitionerRole) Payer managing this group
... member S 1..* BackboneElement Non-matched or consent-constrained members
.... entity S 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
..... Slices for extension Content/Rules for all slices
...... extension:nonMatchedMember S 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.1.1 This IG

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Group C 0..* Group Group of multiple entities
Constraints: grp-1
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Submitted member demographics from provider
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier SΣ 0..* Identifier Provider organization identifier
... active Σ 0..1 boolean Whether this group's record is in active use
... type Σ 1..1 code Group of persons (patients)
Binding: GroupType (required): Types of resources that are part of group.
Required Pattern: person
... actual ΣC 1..1 boolean Actual group (not definitional)
Required Pattern: true
... code SΣ 1..1 CodeableConcept Match result code
Binding: PDex Multi-Member Match Result Value Set (required)
... name Σ 0..1 string Label for Group
... quantity Σ 0..1 unsignedInt Number of members
... managingEntity SΣ 1..1 Reference(Organization | RelatedPerson | Practitioner | PractitionerRole) Payer managing this group
... characteristic 0..* BackboneElement Include / Exclude group members by Trait
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... code 1..1 CodeableConcept Kind of characteristic
Binding Description: (example): List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.
.... value[x] 1..1 Value held by characteristic
Binding Description: (example): Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.
..... valueCodeableConcept CodeableConcept
..... valueBoolean boolean
..... valueQuantity Quantity
..... valueRange Range
..... valueReference Reference(Any)
.... exclude 1..1 boolean Group includes or excludes
.... period 0..1 Period Period over which characteristic is tested
... member SC 1..* BackboneElement Non-matched or consent-constrained members
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... entity S 1..1 Reference(Patient | Practitioner | PractitionerRole | Device | Medication | Substance | Group) Reference to submitted patient demographics
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
...... extension:nonMatchedMember S 0..1 Reference(Patient) Submitted member demographics
URL: http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/base-ext-match-parameters
..... reference ΣC 0..1 string Literal reference, Relative, internal or absolute URL
..... type Σ 0..1 uri Type the reference refers to (e.g. "Patient")
Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
..... identifier Σ 0..1 Identifier Logical reference, when literal reference is not known
..... display Σ 0..1 string Text alternative for the resource
.... period 0..1 Period Period member belonged to the group
.... inactive 0..1 boolean If member is no longer in group

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Group.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Group.type Base required GroupType 📍4.0.1 FHIR Std.
Group.code Base required PDex Multi-Member Match Result Value Set 📦2.1.1 This IG
Group.characteristic.​code Base example Not State Unknown
Group.characteristic.​value[x] Base example Not State Unknown
Group.member.entity.​type Base extensible ResourceType 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
dom-2 error Group If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Group If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Group If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Group If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Group A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()
grp-1 error Group Can only have members if group is "actual" member.empty() or (actual = true)

This structure is derived from Group

Summary

Mandatory: 3 elements
Must-Support: 6 elements

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel, Schematron