Da Vinci Payer Data Exchange
2.2.0 - STU 2.2 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 2.2.0 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

Table of Contents

Page standards status: Informative
.. 0 Table of Contents
... 1 Home
... 2 Overview
... 3 Introduction
... 4 Narrative Conformance
... 5 PDex Implementation Guide
... 6 Security and Privacy
.... 6.1 FHIR Access Permissions
... 7 PDex Implementation, Actors, Interactions, Data Payloads and Methods
.... 7.1 Handling Data Provenance
.... 7.2 Provider Access API
.... 7.3 Provider Access API(v2)
.... 7.4 Payer-to-Payer Exchange (single member)
.... 7.5 Payer-to-Payer Exchange (bulk)
.... 7.6 Data Mapping
..... 7.6.1 US Core AllergyIntolerance
..... 7.6.2 US Core CarePlan
..... 7.6.3 US Core CareTeam
..... 7.6.4 US Core Condition
..... 7.6.5 Consent
..... 7.6.6 Coverage
..... 7.6.7 PDex Device
..... 7.6.8 US Core DiagnosticReport for Laboratory Results Reporting
..... 7.6.9 US Core DiagnosticReport for Report and Note Exchange
..... 7.6.10 US Core DocumentReference
..... 7.6.11 US Core Encounter
..... 7.6.12 US Core Goal
..... 7.6.13 US Core Immunization
..... 7.6.14 US Core ImplantableDevice
..... 7.6.15 US Core Laboratory Result Observation
..... 7.6.16 US Core Location
..... 7.6.17 US Core Medication
..... 7.6.18 PDex MedicationDispense
..... 7.6.19 US Core MedicationRequest
..... 7.6.20 US Core Organization
..... 7.6.21 US Core Patient
..... 7.6.22 US Core Pediatric BMI for Age Observation
..... 7.6.23 US Core Pediatric Head Occipital-frontal Circumference Observation
..... 7.6.24 US Core Pediatric Weight for Height Observation
..... 7.6.25 US Core Practitioner
..... 7.6.26 US Core PractitionerRole
..... 7.6.27 PDex Prior Authorization
..... 7.6.28 US Core Procedure
..... 7.6.29 PDex Provenance
..... 7.6.30 US Core Provenance
..... 7.6.31 US Core Pulse Oximetry
..... 7.6.32 US Core Smoking Status Observation
..... 7.6.33 VitalSigns
... 8 Use Case Scenarios
... 9 CDS Hooks
.... 9.1 Workflow Examples
... 10 Member-Authorized OAuth2.0 Exchange
... 11 Change History
... 12 Credits
... 13 Downloads
... 14 FHIR Artifacts
.... 14.1 PDex Payer-Access Server CapabilityStatement
.... 14.2 PDex provider-access Server CapabilityStatement
.... 14.3 PDEX Server CapabilityStatement
.... 14.4 PDex Server CapabilityStatement with US core 6.1 support
.... 14.5 PDex Bulk Member Match Operation
.... 14.6 PDex Provider-Member-Match Operation
.... 14.7 ExplanationOfBenefit_Identifier
.... 14.8 ExplanationOfBenefit_Patient
.... 14.9 ExplanationOfBenefit_ServiceDate
.... 14.10 ExplanationOfBenefit_Type
.... 14.11 ExplanationOfBenefit_Use
.... 14.12 Group_Code
.... 14.13 PDex Consent Action Search Parameter
.... 14.14 PDex Consent Provider Access Use Case Search Parameter
.... 14.15 PDex Consent Provision Type Search Parameter
.... 14.16 PdexMedicationDispensePatient
.... 14.17 PdexMedicationDispenseStatus
.... 14.18 Member Opt-Out Group
.... 14.19 Member-Provider Treatment Relationship Group
.... 14.20 mTLS Endpoint
.... 14.21 mTLS Endpoint Bundle
.... 14.22 mTLS Organization
.... 14.23 PDex $multi-member-match request
.... 14.24 PDex $multi-member-match response
.... 14.25 PDex Device
.... 14.26 PDex MedicationDispense
.... 14.27 PDex Member Match Group
.... 14.28 PDex Member No Match Group
.... 14.29 PDex Prior Authorization
.... 14.30 PDex Provenance
.... 14.31 PDex Provider Access Consent Profile
.... 14.32 PDex Provider Group
.... 14.33 Provider $multi-member-match Request
.... 14.34 Provider $multi-member-match Response
.... 14.35 Provider Attestation to Treatment Relationship
.... 14.36 Provider Member Match Group
.... 14.37 Provider Member No Match Group
.... 14.38 An attribute to describe the data source a resource was constructed from
.... 14.39 An attribute to express the amount of a service or item that has been utilized
.... 14.40 An attribute to express the refill number of a prescription
.... 14.41 LevelOfServiceCode
.... 14.42 Member Last Resource Filters
.... 14.43 Member Last Resource Types
.... 14.44 Member Last Transmission
.... 14.45 Member-Match Input Patient Parameter
.... 14.46 Members Opted-out
.... 14.47 mTLS Signed Object
.... 14.48 NDH Associated Servers
.... 14.49 NDH Contactpoint Availabletime
.... 14.50 NDH Dynamic Registration
.... 14.51 NDH Endpoint Access Control Mechanism
.... 14.52 NDH Endpoint Rank
.... 14.53 NDH Endpoint Usecase
.... 14.54 NDH FHIR IG
.... 14.55 NDH Identifier Status
.... 14.56 NDH Secure Exchange Artifacts
.... 14.57 NDH Trust Framework
.... 14.58 NDH Verification Status
.... 14.59 Opt-Out Details
.... 14.60 Opt-Out Reason
.... 14.61 Provider Access Use Case
.... 14.62 ReviewAction
.... 14.63 ReviewActionCode
.... 14.64 Treatment Relationship Details
.... 14.65 When Adjudicated
.... 14.66 Endpoint Payload Type Value Set
.... 14.67 FDA National Drug Code (NDC)
.... 14.68 mTLS Signed Object Types
.... 14.69 Opt-Out Reason
.... 14.70 Opt-Out Scope
.... 14.71 Organization Type VS
.... 14.72 Payer source of data
.... 14.73 PDex Adjudication
.... 14.74 PDex Adjudication Category Discriminator
.... 14.75 PDex Multi-Member Match Result Value Set
.... 14.76 PDex Payer Benefit Payment Status
.... 14.77 PDex SupportingInfo Type
.... 14.78 Prior Authorization Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS
.... 14.79 Prior Authorization Service Type Codes (X12)
.... 14.80 Prior Authorization value categories
.... 14.81 Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS
.... 14.82 Provenance Agent Type
.... 14.83 Treatment Attestation Provision Type
.... 14.84 Treatment Attestation Status
.... 14.85 Treatment Relationship Type
.... 14.86 Trust Framework Type Value Set
.... 14.87 X12 278 Review Decision Reason Codes
.... 14.88 X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes
.... 14.89 Endpoint Payload Types Code System
.... 14.90 mTLS Object Type Code
.... 14.91 Opt-Out Reason
.... 14.92 Opt-Out Scope
.... 14.93 Organization Type
.... 14.94 PDex Adjudication Discriminator
.... 14.95 PDex Identifier Type
.... 14.96 PDex Member Characteristic Code
.... 14.97 PDex Multi-Member Match Result Code System
.... 14.98 PDex Payer Adjudication Status
.... 14.99 PDex Provider Access API Attribution Code System
.... 14.100 PDex Supporting Info Type
.... 14.101 Prior Authorization Values
.... 14.102 Provenance Payer Data Source Format
.... 14.103 Provenance Roles
.... 14.104 Treatment Relationship Type
.... 14.105 Trust FrameworkType Code System
.... 14.106 Trust Profile Code System
.... 14.107 $multi-member-match payer example request
.... 14.108 $multi-member-match payer example response
.... 14.109 Acme
.... 14.110 BundleConditionWithProvenance
.... 14.111 BundleExamplePayer1
.... 14.112 BundleExamplePayer2
.... 14.113 BundleExamplePayer3
.... 14.114 BundleWithProvenance
.... 14.115 consentin2
.... 14.116 Coverage to Link Example 1
.... 14.117 Coverage to Match Example 1
.... 14.118 Coverage to Match Example 2
.... 14.119 coveragein2
.... 14.120 coveragelink2
.... 14.121 diamond-mtls-endpoint1
.... 14.122 diamond-mtls-endpoint2
.... 14.123 Example Member Opt-Out Group
.... 14.124 Example Member-Provider Treatment Relationship Group
.... 14.125 example-mtls-endpoint-bundle
.... 14.126 example-pdex-member-consent-constraint-group
.... 14.127 example-pdex-member-match-group
.... 14.128 example-pdex-member-no-match-group
.... 14.129 Example-PDex-Provider-Group
.... 14.130 ExampleBundle1
.... 14.131 ExampleCoverage
.... 14.132 ExampleDevice
.... 14.133 ExampleDocRefProvenance
.... 14.134 ExampleDocumentReference
.... 14.135 ExampleEncounter1
.... 14.136 ExampleEncounter2
.... 14.137 ExampleEncounter3
.... 14.138 ExampleLocation
.... 14.139 ExampleMedicationDispenseClaim
.... 14.140 ExamplePractitioner
.... 14.141 ExampleProvenanceAuthorEncounter6
.... 14.142 ExampleProvenanceAuthorEncounter7
.... 14.143 ExampleProvenanceBundleTransmitter
.... 14.144 ExampleProvenanceCustodian
.... 14.145 ExampleProvenancePayerModified
.... 14.146 ExampleProvenancePayerSource
.... 14.147 ExampleProvenanceSoloPractitioner
.... 14.148 ExampleProvenanceTransmitter
.... 14.149 mtlsorganization2
.... 14.150 Organization Provider Example 1
.... 14.151 Organization Provider Example 2
.... 14.152 OrganizationPayer1
.... 14.153 OrganizationPayer1-1
.... 14.154 OrganizationPayer2
.... 14.155 OrganizationPayer2-2
.... 14.156 OrganizationProvider1
.... 14.157 OrganizationProvider2
.... 14.158 Patient for Member Match Example 1
.... 14.159 Patient for Member Match Example 2
.... 14.160 Patient Provider Example 1 - Robert Johnson
.... 14.161 Patient Provider Example 2 - Sarah Williams
.... 14.162 Patient1
.... 14.163 Patient1-2
.... 14.164 Patient100
.... 14.165 Patient1001
.... 14.166 Patient2002
.... 14.167 patientin2
.... 14.168 Payer Member Example 1 - Robert Johnson
.... 14.169 Payer Member Example 2 - Sarah Williams
.... 14.170 Payer's Patient Record for Member 1001
.... 14.171 Payer's Patient Record for Member 2002
.... 14.172 PDex Provider Access Consent Opt-Out Example
.... 14.173 PDex Provider Access Consent Permit Example
.... 14.174 PDexCoverageExample
.... 14.175 PdexPriorAuth
.... 14.176 Practitioner Provider Example 1 - Dr. Smith
.... 14.177 Practitioner Provider Example 2 - Dr. Jones
.... 14.178 Provider Attestation Document Reference
.... 14.179 Provider Bulk Member Match Request Example
.... 14.180 Provider Bulk Member Match Response Example
.... 14.181 Provider Treatment Attestation Consent Example for Bulk Member Match
.... 14.182 Provider-Member-Match Request Example
.... 14.183 Provider-Member-Match Response Example
.... 14.184 Treatment Attestation Example 1
.... 14.185 Treatment Attestation Example 2
.... 14.186 Treatment Attestation Form Example 1
.... 14.187 Treatment Attestation Form Example 2
... 15 Other IG Artifacts