Da Vinci Payer Data Exchange
2.1.0 - STU2 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 2.1.0 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

Change History

Page standards status: Informative

Previous Page - Member-Authorized OAuth2 Exchange

STU 2.1.0 Update

JIRA Ticket Change
Edited Scopes for Operations Edited scopes for Operations used in Payer-to-Payer and Provider Access APIs
Added Informative Extension to Pages Added Informative Extension to Pages in Sushi-config.yaml
Added Change History to Menu Add Change History page to Menu
FHIR-45364 Provide Use case examples for use of custom extensions in PDex Provider Group
Update Clinical-Financial picture in overview.md Update Clinical Financial image on overview page.
FHIR-45356 Change milsEndpoint examples to use correct code from NdhAssociatedServersTypeCS
FHIR-45355 Removed copied NDH Extensions, Code Systems and Value Sets. Point to content in NDH 1.0.0-ballot, allowing replicated content to be removed from PDex.
FHIR-45352 Added support for US Core 6.1.0 in addition to US Core 3.1.1. Based on L McKenzie Publishing Guidance
New MembersOptedOut Extension Extension to capture number of Attributed Members excluded from the list through Opt-Out
TC: FHIR-44906 Fix broken link to Bulk Data Access IG
Add DaVinci-data-export-operation to Other-igs.md Add link to Da Vinci Data Export Operation in other-igs.md
Expand narrative for Provider Access and Payer-to-Payer APIs Removed ExportModeVS and ExportModeCS, replaced by exportType with fragment
FHIR-44807 Drop Must Support from item.adjudication[consumeUnits] In PDex Prior Authorization
Add Provider Access API Diagram Created Plantuml for Provider Access API
Decision to remove optout members from Group Remove OptOut Extension
Define OptedOut Extension to capture member optout Added OptedOut Extension to PDexProviderGroup to record member opt out from data sharing with attributedproviders

STU 2.0.0-ballot:Ballot Reconciliation

JIRA Ticket Change
Payer-to-Payer Bulk Exchange Draft Draft of PDex Multi Member Match Operation and Request and Response Bundles
TC: endpoint example Update Endpoint example with new Trust Framework certificates in Base64Binary
TC: FHIR-41675 Remove duplicate codes from Provenance Agent Type
TC: FHIR-41497 Missing reference to CDS Hooks diagram
TC: FHIR-41399 Text states “US Core v3.1.1” but URL behind “US Core FHIR R4” points to US Core V 6.0.0
TC: FHIR-41398 Typo at the bottom of section (“4.2” vs. “5.2”)
FHIR-41381 Add narrative stating that the Prior Authorization profile also applies to the Payer to Payer use case
NDH Profiles and Extensions Imported unpublished NDH Profiles, Extensions, CodeSystems and ValueSets into PDex for mTLS support
FHIR-41307 Conflicting Links to HRex Coverage Profile
FHIR-41177 Capturing adjudication (determination) date for pre-auth
FHIR-40517 Section numbering is broken
Created Examples for mTLS Created Examples for MtlsOrganization and MtlsEndpoint
FHIR-40357 Possible typo in Data Mapping specification
FHIR-40239 Missing endpoint URLs?
FHIR-36626 Review all mappings as significant errors have been detected - Reviewed against CARIN-BB STU2
FHIR-36602 Review all mappings as significant errors have been detected in the above mappings and are expected in other mappings.- Reviewed against CARIN-BB STU2
FHIR-36601 Review all mappings for DiagnosticReport - Reviewed against CARIN-BB STU2
FHIR-36598 Review all mappings for Encounter - Reviewed against CARIN-BB STU2
QA Report Fixes Apply fixes to resolve QA Report Errors.
TC: FHIR-39434 Update table of profiles for payer-to-payer exchange
FHIR-39424 We need a new OperationDefinition for patient-export-pdex
FHIR-39314 Need detail w.r.t. reconciling new session with Consent from earlier interaction
FHIR-36626 Review all mappings as significant errors have been detected - fixed table layout and reconcile to CARIN-BB STU2 - CareTeam, Condition, Coverage, Encounter
TC: FHIR-38767 Typo in Future Direction for Discovery and Registration
FHIR-38708 Clarification on payer directory queries
FHIR-38707 Clarifications on dynamic client registration and first token request
FHIR-38706 Consent reference to DocumentReference in member match request clarification -
TC: FHIR-38705 Endpoint bundle example is not valid
TC: FHIR-38696 Wrong link - NationalDirectory Endpoint resource
FHIR-38650 PDex defines an incorrect request pattern for Patient-level bulk export
FHIR-38097 ExplanationOfBenefit description clarification for use of item level, header level adjudication
FHIR-38096 For Pdex Prior Authorization EOB, reviewAction extension not available at header level adjudication.
FHIR-37904 Add Privacy and Security section to IG
FHIR-36598 Review all mappings for Encounter.
FHIR-36495 CDS Card should not return an access token
FHIR-36315 Unclear definitions of filtering vs restricting cases
TC: FHIR-36174 Correction in StructureDefinition-pdex-provenance
Added mTLS Discovery Profiles Added mTLS Discovery profiles and referenced in Payer-to-Payer Exchange page.
FHIR-37778 Link to the HREX Coverage takes you to the Patient Demographic Profile
FHIR-37645 Consent presentation for P2P
FHIR-37644 Consent Revocation for P2P
FHIR-36599 Review 835 and all mappings to diagnostics.
FHIR-36572 Create a Formal Specification or Conformance Expectations page/section
FHIR-36462 Incorrect Diagram, Consent considerations, everything operation (Duplicate of FHIR-36461)
FHIR-36254 Missing details of payer-to-payer mutual authentication
FHIR-36223 PDEX defined their own version of an already existing code system
TC: FHIR-36176 Correction needed in ExplanationOfBenefit-PDexPriorAuth1.json
FHIR-36078 CareTeam for a patient is not the same thing as “a random collection of Providers that treated the patient once”
FHIR-37577 Change use of _profile to ExplanationOfBenefit.use to filter on “preauthorization”
FHIR-37576 Duplicate to FHIR-37577
FHIR-37546 Consent expiration for P2P Data Exchange
FHIR-36767 $member-match operation conformance not defined
FHIR-36629 change from are expected to SHALL
FHIR-36601 Review all mappings for DiagnosticReport (MedicationDispense).
FHIR-36462 Incorrect Diagram, Consent considerations, everything operation
FHIR-36885 ExplanationOfBenefit.use = preauthorization
FHIR-36772 PDEX Provenance page. Broken section
FHIR-36767 $member-match operation conformance not defined
FHIR-36600 Review all mappings for Coverage
FHIR-36597 Invalid data population instruction for Condition
FHIR-36596 Invalid data population instruction for CareTeam
FHIR-36563 No issues; this section is dense but necessary in defining scope.
FHIR-36352 Expand CPCDS Undefined Acronym
FHIR-36337 Update Name Column for Lab Result
TC: FHIR-36075 Link to US Core 3.1.1 actually links to HL7 home
TC: FHIR-36314 Formatting fixes in Care Team element table
TC: FHIR-37366 Vital Signs not referenced in Capability Statement
FHIR-36603 Note that CPCDS is external and informative
FHIR-36580 Update references to HRex to published 1.0.0 version
TC: FHIR-36575 Make the CapabilityStatement rendering more reader friendly
FHIR-36573 Correction: Added pages to drop-down menu
TC: FHIR-36569 Create a Change Notes or History page
FHIR-36564 Add clarifying markup for CPCDS mapping tables
FHIR-36562 Add CARIN Acronym on first use
TC: FHIR-36255 Formatting issues for PDEX server capability statement
FHIR-36237 Sending Duplicative Data
TC: FHIR-36080 link to published FHIR v4.0.1
TC: FHIR-36079 removed double link to ChangeHistory

Technical Corrections are prefixed with “TC: “

STU 2.0.0

The following changes were applied in the Proposed STU 2.0.0 update:

JIRA Ticket Change
TC: FHIR-36026 Multiple Technical Corrections
FHIR-35868 Revert US Core References back to 3.1.1
FHIR-34308 Update US Core and PDex inter-relationship diagram to add Prior Auth in Overview page.
FHIR-33382 Change references to US Core to link to the current 4.0.0 version. Reverted - see FHIR-35868 above.
FHIR-33218 Update Payer-to-Payer Exchange section to clarify use of Bulk FHIR protocols for retrieval of data for a single patient/member only. The flow has been subject to substantial assessment at multiple connectathons and test events.
FHIR-33217 Add a PDex Prior Authorization profile, based on the EOB resource to support the exchange of Prior Authorization information with Members. Added Slices to item adjudication and added consumedunits slice
FHIR-33141 Revert PDex Provenance Recorded definition to the US Core Provenance version
FHIR-33173 Add clarification to use of $everything operation - superceded by updates to Payer-to-Payer exchange
FHIR-33216 Add guidance for use of Consent resource in $member-match operation - superceded by updated to Payer-to-Payer exchange
FHIR-33713 Add Provenance custodian record for receipt of member data from prior payer

Next Page - Credits