This page is part of the Da Vinci - Member Attribution (ATR) List (v2.1.0: STU 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Member Attribution List Implementation Guide Home Page

Official URL: http://hl7.org/fhir/us/davinci-atr/ImplementationGuide/hl7.fhir.us.davinci-atr				Version: 2.1.0
IG Standards status: Trial-use			Maturity Level: 2	Computable Name: MemberAttributionList

Overview

Member Attribution (ATR) lists are used between Payers and Providers for implementing risk-based contracts, value based contracts, care gap closures and quality reporting. The processes of establishing and exchanging Member Attribution Lists are complex and time consuming. Currently there are no standards in use for establishing and exchanging risk-based contract member lists between payers and providers. The most common method in use today involves the creation of files (CSVs, txt etc) and exchanging them using various methods such as Email and Secure File Transfer Protocol (SFTP).This implementation guide will use HL7 FHIR to specify standards for the exchange of Member Attribution Lists between providers and payers. The list can be used by providers and payers to implement use cases for Value Based Contracts (VBC), Quality Reporting, Da Vinci Payer Data Exchange (PDex) and Da Vinci Clinical Data Exchange (CDex) among others.

The purpose of this implementation guide is to define the mechanisms (APIs, protocols), data structures and value sets to be used for exchanging the Member Attribution List. The Member Attribution List typically contains the following information:

• Plan/Contract Information which is the basis for the Member Attribution list
• Patient Information
• Attributed Individual Provider Information
• Attributed Organization Information
• Member and Subscriber Coverage Information

This implementation guide is designed to allow

• Exchange of a Full Member Attribution Lists.
• Requesting changes to existing Member Attribution Lists.
• Request and receive notifications of changes to Member Attribution Lists.

Content and Organization

The implementation guide is organized into the following sections:

• Use Cases and Overview describes the intent of the implementation guide, gives examples of its use and provides a high-level overview of expected process flow
• Technical Background describes the other specifications this implementation guide relies on. It also indicates what developers should read and understand prior to implementing this specification
• Formal Specification covers the detailed implementation requirements and conformance expectations
• Artifacts introduces and provides links to the FHIR R4 profiles, search parameters and other FHIR artifacts used in this implementation guide
• Downloads - provides downloadable versions of this and other specifications as well as other useful files
• Credits identifies the individuals and organizations involved in developing this implementation guide

Dependencies

At present, ATR IG is based on FHIR R4. In addition, this guide also relies on a number of parent implementation guides:

Implementation Guide	Version(s)	Reason
Bulk Data Access IG	2.0.0
CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)	2.0.0	Imported by Da Vinci Prior Authorization Support (PAS) FHIR IG (and potentially others)
Da Vinci - Coverage Requirements Discovery	2.1.0	Imported by Da Vinci - Documentation Templates and Rules (and potentially others)
	2.0.0	Imported by Da Vinci Prior Authorization Support (PAS) FHIR IG (and potentially others)
Da Vinci - Documentation Templates and Rules	2.1.0	Imported by Da Vinci Clinical Data Exchange (CDex) (and potentially others)
Da Vinci Clinical Data Exchange (CDex)	2.1.0
Da Vinci Health Record Exchange (HRex)	1.1.0	Imported by Da Vinci PDex Plan Net (and potentially others)
	1.0.0	Imported by Da Vinci - Coverage Requirements Discovery (and potentially others)
Da Vinci PDex Plan Net	1.2.0
Da Vinci Prior Authorization Support (PAS) FHIR IG	2.1.0	Imported by Da Vinci Clinical Data Exchange (CDex) (and potentially others)
FHIR Extensions Pack	5.2.0	Automatically added as a dependency - all IGs depend on the HL7 Extension Pack
	5.1.0	Imported by Da Vinci Health Record Exchange (HRex) (and potentially others)
	1.0.0	Imported by Da Vinci - Coverage Requirements Discovery (and potentially others)
FHIR R4 package : Core	4.0.1	Imported by HL7 Terminology (THO) (and potentially others)
HL7 Terminology (THO)	6.3.0	Automatically added as a dependency - all IGs depend on HL7 Terminology
	6.2.0	Imported by Da Vinci PDex Plan Net (and potentially others)
	6.1.0	Imported by Da Vinci Health Record Exchange (HRex) (and potentially others)
	5.5.0	Imported by US Core (and potentially others)
	5.3.0	Imported by Da Vinci - Coverage Requirements Discovery (and potentially others)
	5.0.0	Imported by SMART App Launch (and potentially others)
Public Health Information Network Vocabulary Access and Distribution System (PHIN VADS)	0.12.0	Imported by US Core (and potentially others)
SMART App Launch	2.1.0
	2.0.0	Imported by US Core (and potentially others)
Security for Scalable Registration, Authentication, and Authorization	0.1.0	Imported by Da Vinci Health Record Exchange (HRex) (and potentially others)
Structured Data Capture	3.0.0	Imported by US Core (and potentially others)
Subscriptions R5 Backport	1.1.0
US Core	7.0.0	Defines US Core EHR expectations on a range of resources that will be queried by ATR clients.
	6.1.0	Defines US Core EHR expectations on a range of resources that will be queried by ATR clients.
	3.1.1	Defines US Core EHR expectations on a range of resources that will be queried by ATR clients.
Value Set Authority Center (VSAC)	0.7.0	Imported by CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) (and potentially others)
	0.19.0	Imported by Da Vinci Health Record Exchange (HRex) (and potentially others)
	0.18.0	Imported by US Core (and potentially others)
	0.11.0	Imported by Da Vinci - Coverage Requirements Discovery (and potentially others)

This implementation guide defines additional constraints and usage expectations above and beyond the information found in these base specifications.

Intellectual Property Considerations

This implementation guide and the underlying FHIR specification are licensed as public domain under the FHIR license. The license page also describes rules for the use of the FHIR name and logo.

This publication includes IP covered under the following statements.

• Copyright HL7. Licensed under creative commons public domain
  Show Usage
  • bedStatus: South Wing, second floor
  • contactRole2: RelatedPerson/1
  • providerRole: PractitionerRole/1
• 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
  Show Usage
  • ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: ATRCoverage, ATRGroup... Show 29 more, ATRLocation, ATROrganization, ATRPatient, ATRPractitioner, ATRPractitionerRole, ATRRelatedPerson, AtrAnyResourceExtension, AtrIntendedRecipientIdentifierExtension, AtrListChangeSubscription, AttributedProvider, AttributionListStatus, AttributionStatus, ChangeType, ConfirmAttributionList, ContractValidityPeriod, CoverageReference, DaVinciAtrChangeType, DaVinciAtrChangeTypeCodes, DaVinciAtrConsumer, DaVinciAtrProducer, DaVinciAttributionListStatus, DaVinciDataExport, DaVinciGroupCharacteristic, DaVinciGroupCharacteristicCodes, DaVinciPatientList, InsuranceProductType, MemberAdd, MemberAttributionList and MemberRemove
• 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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  • SNOMED Clinical Terms® (SNOMED CT®): Patient/1, Patient/2 and PractitionerRole/1
• 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
  Show Usage
  • Contact entity type: Burgers UMC Cardiology unit
  • Coverage Class Codes: Coverage/1, Coverage/2 and Coverage/3
  • Location type: South Wing, second floor
  • Organization type: Burgers UMC Cardiology unit and Example Organization
  • SubscriberPolicyholder Relationship Codes: Coverage/1, Coverage/2 and Coverage/3
  • identifierType: Coverage/1, Coverage/2... Show 5 more, Coverage/3, Patient/1, Patient/2, Patient/3 and Test Group 3
  • MaritalStatus: Patient/1, Patient/2 and Patient/3
  • RoleCode: RelatedPerson/1 and RelatedPerson/2