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

Consent

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Consent is used in two places in this Implementation Guide:

1. Payer-to-Payer Member Match
2. Provider Access API Member Opt-out

Payer-to-Payer Member Match

In Payer-to-Payer Member Match the requesting payer will include a HRex Consent record. The record records the Member's agreement to allow the requesting Payer to retrieve data from the member's old health plan and identifies the scope of the data to be retrieved: all data, or only Non-Sensitive data.

Provider Access Opt-out

The CMS Prior Authorization Rule (CMS-0057) requires that a health plan enables a member to choose to opt-out of sharing their data with providers via the Provider Access API. By default a member is opted-in to data sharing with Providers that have an existing, or impending treatment relationship. This implementation Guide provides a Consent profile that expresses a Member's decision to opt-out, i.e., Deny sharing of their data, A Member can also revoke that denial.

While it is expected that health plans MAY implement their own processes and communication methods to track and act upon a member opting out of Provider Access AI data sharing, the following profile is provided as an example of a Consent resource that could be used to express a member opt-out. This MAY be used by a member portal, or consumer app to communicate an opt-out from Provider Access sharing.

PDex Provider Consent Profile.

Example Member Opt-out: PDex Provider Access API Opt-out.

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