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
Other IG Artifacts
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Other Implementation Guides
An important objective in the HL7 Da Vinci Accelerator Project is to avoid
unnecessary profile proliferation and to leverage common processes. To this end
the PDex IG leverages the profiles, extensions and operations incorporated into
other Implementation Guides.
Implementation Guides
PDex references the following Implementation Guides:
Note: The FAST National Directory (NDH) IG has yet to be published. To enable PDex to leverage the profiles and extensions in the NDH IG the required Profiles, Extensions, Value Sets and Code Systems have been copied into PDex. Once the NDH IG is published it is intended that the PDex IG would remove the NDH content in a future PDex STU update and reference the FAST NDH IG directly.
Profiles
The following profiles are referenced in this IG:
US Core
Health Record Exchange (HRex)
Da Vinci Member Attribution (ATR)
Operations
The following operations are referenced:
Health Record Exchange (HRex)
Da Vinci Member Attribution (ATR)
IG/package dependencies
The following dependencies are used in production of this guide:
Cross version analysis
This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (hl7.fhir.us.davinci-pdex.r4) and R4B (hl7.fhir.us.davinci-pdex.r4b) are available.
IP Statements
This publication includes IP covered under the following statements.
- All X12 products are subject to this IP policy, including published and draft works.X12 is the only organization authorized to grant permission for use of X12 products. Users of all X12 products should make sure that they understand the permissible uses, as well as the limitations on such usage, as outlined below.Additional IP information can be found here
Send an email to ip@x12.org to request permission to reproduce X12 IP. Include your name, organization, title, address, city, state, zip, email, a detailed description of the Submitted Artifact, including the underlying or cited X12 Product, and a detailed description of the intended audience and planned distribution method for the Artifact.Additional information on X12 licensing program can be found here
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- All X12 work products are copyrighted. Any use of any X12 work product must be compliant with US Copyright laws and X12 Intellectual Property policies.Please see https://x12.org/products/licensing-program
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- CMS maintains HIPPS. There are no known constraints on the use of HIPPS.
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- ISO Maintains the copyright on the country codes, and controls it's use carefully. For futher details see the ISO 3166 web page: https://www.iso.org/iso-3166-country-codes.html
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- ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: AssociatedServers, BulkMemberMatch... Show 78 more, ContactPointAvailableTime, DaVinciPayerDataExchange, DispenseRefill, DynamicRegistration, EndpointAccessControlMechanism, EndpointConnectionTypeVersion, EndpointRank, EndpointUsecase, ExplanationOfBenefit_Identifier, ExplanationOfBenefit_Patient, ExplanationOfBenefit_ServiceDate, ExplanationOfBenefit_Type, ExplanationOfBenefit_Use, FDANationalDrugCode, FhirIg, Group_Code, IdentifierStatus, IdentifierTypeCS, LastFilters, LastTransmission, LastTypes, LevelOfServiceCode, MatchParameters, MembersOptedOut, MtlsBundle, MtlsEndpoint, MtlsObjectCodeCS, MtlsObjectTypeVS, MtlsOrganization, MtlsSignedObject, OrgTypeCS, OrgTypeVS, PDexAdjudication, PDexAdjudicationCS, PDexAdjudicationCategoryDiscriminator, PDexAdjudicationDiscriminator, PDexIdentifierType, PDexMemberMatchGroup, PDexMemberNoMatchGroup, PDexMultiMemberMatchRequestParameters, PDexMultiMemberMatchResponseParameters, PDexMultiMemberMatchResultVS, PDexPAInstitutionalProcedureCodes, PDexPAInstitutionalProcedureCodesVS, PDexPayerAdjudicationStatus, PDexPayerBenefitPaymentStatus, PDexProviderGroup, PDexProviderSharingConsent, PDexServerCapabilityStatement61, PDexSupportingInfoType, PdexDevice, PdexMedicationDispense, PdexMedicationDispensePatient, PdexMedicationDispenseStatus, PdexMemberAttributionCS, PdexMultiMemberMatchResultCS, PdexPayerAccessServerCapabilityStatement, PdexPriorAuthorization, PdexProviderAccessServerCapabilityStatement, PdexServerCapabilityStatement, PriorAuthServiceTypeCodes, PriorAuthorizationAmounts, PriorAuthorizationUtilization, PriorAuthorizationValueCodes, Provenance, ProvenanceAgentRoleType, ProvenanceAgentType, ProvenancePayerDataSource, ProvenancePayerSourceFormat, ProvenanceSourceFrom, ReviewAction, ReviewActionCode, SecureExchangeArtifacts, TrustFramework, VerificationStatus, WhenAdjudicated, X12278ReviewDecisionReasonCode and X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes
- These codes are excerpted from ASTM Standard, E1762-95(2013) - Standard Guide for Electronic Authentication of Health Care Information, Copyright by ASTM International, 100 Barr Harbor Drive, West Conshohocken, PA 19428. Copies of this standard are available through the ASTM Web Site at www.astm.org.
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- This CodeSystem is not copyrighted.
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- This is an example set based on ASTM Standard, E1762-95 (2013) HL7 RoleClass OID 2.16.840.1.113883.5.110, HL7 Role Code 2.16.840.1.113883.5.111, HL7 ParticipationType OID: 2.16.840.1.113883.5.90, HL7 ParticipationFunction codes at OID: 2.16.840.1.113883.5.88, and HL7 Security and Privacy Domain Analysis Model roles classes.
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- This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
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- This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
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- This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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- Adjudication Value Codes: ExplanationOfBenefit/PDexPriorAuth1, PDexAdjudication and PdexPriorAuthorization
- Claim Type Codes: ExplanationOfBenefit/PDexPriorAuth1
- Condition Category Codes: Bundle/3000003
- Condition Clinical Status Codes: Bundle/3000003
- ConditionVerificationStatus: Bundle/3000003
- Consent Action Codes: Consent/no-consent-1, PDexProviderSharingConsent and Parameters/payer-multi-member-match-in
- Consent PolicyRule Codes: Consent/no-consent-1 and PDexProviderSharingConsent
- Consent Scope Codes: Consent/no-consent-1, PDexProviderSharingConsent and Parameters/payer-multi-member-match-in
- Coverage Class Codes: Parameters/payer-multi-member-match-in
- DataAbsentReason: PDexPAInstitutionalProcedureCodes, PDexPAInstitutionalProcedureCodesVS and PdexPriorAuthorization
- Endpoint Connection Type: Bundle/example-mtls-endpoint-bundle, MtlsEndpoint and Payer-Payer Exchange
- Example Diagnosis Type Codes: ExplanationOfBenefit/PDexPriorAuth1
- Example Related Claim Relationship Codes: ExplanationOfBenefit/PDexPriorAuth1
- Funds Reservation Codes: ExplanationOfBenefit/PDexPriorAuth1
- Process Priority Codes: ExplanationOfBenefit/PDexPriorAuth1 and PdexPriorAuthorization
- Provenance participant type: Bundle/1000000-1, Bundle/1000000-2... Show 13 more, Bundle/1000000-3, Bundle/3000003, Consent/no-consent-1, PDexProviderSharingConsent, Parameters/payer-multi-member-match-in, Provenance, Provenance/1000002, Provenance/1000003, Provenance/1000004, Provenance/1000005, Provenance/1000006, Provenance/1000101 and ProvenanceAgentType
- SubscriberPolicyholder Relationship Codes: Coverage/883210, Coverage/Coverage1 and Parameters/payer-multi-member-match-in
- identifierType: Bundle/1000000-1, Bundle/1000000-2... Show 13 more, Bundle/1000000-3, Coverage/883210, Coverage/Coverage1, Group/example-pdex-member-consent-constraint-group, Group/example-pdex-member-no-match-group, Matched Members, Parameters/payer-multi-member-match-in, Parameters/payer-multi-member-match-out, Patient/1, Patient/1-2, Patient/100, Patient/1001 and Patient/2002
- ActCode: Bundle/1000000-1, Bundle/1000000-2... Show 11 more, Bundle/1000000-3, Bundle/2000002, Bundle/3000002, Consent/no-consent-1, Encounter/6, Encounter/7, Encounter/8, MedicationDispense/1000001, PDexProviderSharingConsent, Parameters/payer-multi-member-match-in and PdexMedicationDispense
- ActReason: Provenance/1000101
- DataOperation: Provenance/1000101
- NullFlavor: Bundle/1000000-1, Bundle/1000000-2... Show 4 more, Bundle/1000000-3, Patient/1, Patient/1-2 and Patient/100
- ParticipationType: Parameters/payer-multi-member-match-in
- Used by permission of HL7 International, all rights reserved Creative Commons License
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- US Core DocumentReferences Category Codes: DocumentReference/123456
- US Core Provenance Participant Type Extension Codes: Bundle/1000000-1, Bundle/1000000-2... Show 8 more, Bundle/1000000-3, Bundle/3000002, Provenance, Provenance/1000001, Provenance/1000016, Provenance/1000017, Provenance/1000101 and ProvenanceAgentType
- Identifier Type: Payer 1, Payer 2, Practitioner/4, Provider 1 and Provider 2
- mTLS Object Type Code: MtlsObjectTypeVS, MtlsSignedObject and Payer-Payer Exchange
- Organization Type: Acme of CT and OrgTypeVS
- PDex Provider Access API Attribution Code System: Attributed List of Health Plan Members for Practitioner 1122334455., PDexMemberMatchGroup, PDexMemberNoMatchGroup, PDexMultiMemberMatchResultVS and PDexProviderGroup
- PDex Multi-Member Match Result Code System: Group/example-pdex-member-consent-constraint-group, Group/example-pdex-member-no-match-group... Show 6 more, Matched Members, PDexMemberMatchGroup, PDexMemberNoMatchGroup, PDexMultiMemberMatchResultVS, PDexProviderGroup and Parameters/payer-multi-member-match-out
- Prior Authorization Values: ExplanationOfBenefit/PDexPriorAuth1, PdexPriorAuthorization and PriorAuthorizationAmounts
- Provenance Roles: Provenance and ProvenanceAgentType
- Provenance Payer Data Source Format: Bundle/1000000-1, Bundle/1000000-2... Show 13 more, Bundle/1000000-3, Bundle/3000002, Bundle/3000003, Provenance, Provenance/1000001, Provenance/1000002, Provenance/1000003, Provenance/1000004, Provenance/1000005, Provenance/1000006, Provenance/1000016, ProvenancePayerSourceFormat and ProvenanceSourceFrom
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