Da Vinci Health Record Exchange (HRex)
0.2.0 - STU R1 - 2nd ballot

This page is part of the Da Vinci Health Record Exchange (v0.2.0: STU1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions

: HRex Member Match Operation - XML Representation

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<OperationDefinition xmlns="http://hl7.org/fhir">
  <id value="member-match"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><h2>MemberMatch</h2><p>OPERATION: MemberMatch</p><p>The official URL for this operation definition is: </p><pre>http://hl7.org/fhir/us/davinci-hrex/OperationDefinition/member-match</pre><div><p>The <strong>$member-match</strong> operation allows one health plan to retrieve a unique identifier for a member from another health plan using a member's demographic and coverage information.  This identifier can then be used to perform subsequent queries and operations.</p>
</div><p>URL: [base]/Patient/$member-match</p><p>Parameters</p><table class="grid"><tr><td><b>Use</b></td><td><b>Name</b></td><td><b>Cardinality</b></td><td><b>Type</b></td><td><b>Binding</b></td><td><b>Documentation</b></td></tr><tr><td>IN</td><td>MemberPatient</td><td>1..1</td><td><a href="http://hl7.org/fhir/R4/resource.html">Resource</a></td><td/><td><div><p>Parameter submitted by the new plan <strong>SHALL</strong> contain US Core Patient containing member demographics.</p>
</div></td></tr><tr><td>IN</td><td>OldCoverage</td><td>1..1</td><td><a href="http://hl7.org/fhir/R4/resource.html">Resource</a></td><td/><td><div><p>Parameter submitted by the new plan <strong>SHALL</strong> contain Coverage details of prior health plan coverage provided by the member, typically from their health plan coverage card.</p>
</div></td></tr><tr><td>IN</td><td>NewCoverage</td><td>1..1</td><td><a href="http://hl7.org/fhir/R4/resource.html">Resource</a></td><td/><td><div><p>Parameter submitted by the new plan <strong>SHALL</strong> contain Coverage details of new or prospective health plan coverage provided by the new health plan based upon the member's enrollment.</p>
</div></td></tr><tr><td>OUT</td><td>MemberPatient</td><td>1..1</td><td><a href="http://hl7.org/fhir/R4/resource.html">Resource</a></td><td/><td><div><p>Parameter returned by the old plan resource <strong>SHALL</strong> contain the MemberPatient resource received from new plan with the ADDITION of an identifier of type &quot;UMB&quot; representing the unique identifier identifying the member of the old health plan.</p>
</div></td></tr><tr><td>OUT</td><td>NewCoverage</td><td>1..1</td><td><a href="http://hl7.org/fhir/R4/resource.html">Resource</a></td><td/><td><div><p>Parameter returned by the old plan resource <strong>SHALL</strong> contain the NewCoverage record received from the new plan.</p>
</div></td></tr></table></div>
  </text>
  <url
       value="http://hl7.org/fhir/us/davinci-hrex/OperationDefinition/member-match"/>
  <version value="0.2.0"/>
  <name value="MemberMatch"/>
  <title value="HRex Member Match Operation"/>
  <status value="draft"/>
  <kind value="operation"/>
  <date value="2020-08-09T15:38:40+00:00"/>
  <publisher value="HL7 International - Clinical Interoperability Council"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/cic"/>
    </telecom>
  </contact>
  <description
               value="The **$member-match** operation allows one health plan to retrieve a unique identifier for a member from another health plan using a member&#39;s demographic and coverage information.  This identifier can then be used to perform subsequent queries and operations."/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <code value="member-match"/>
  <resource value="Patient"/>
  <system value="false"/>
  <type value="true"/>
  <instance value="false"/>
  <inputProfile
                value="http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-parameters-member-match-in"/>
  <outputProfile
                 value="http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-parameters-member-match-out"/>
  <parameter>
    <name value="MemberPatient"/>
    <use value="in"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="Parameter submitted by the new plan **SHALL** contain US Core Patient containing member demographics."/>
    <type value="Resource"/>
    <referencedFrom>
      <source value="OldCoverage"/>
      <sourceId value="beneficiary"/>
    </referencedFrom>
    <referencedFrom>
      <source value="NewCoverage"/>
      <sourceId value="beneficiary"/>
    </referencedFrom>
  </parameter>
  <parameter>
    <name value="OldCoverage"/>
    <use value="in"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="Parameter submitted by the new plan **SHALL** contain Coverage details of prior health plan coverage provided by the member, typically from their health plan coverage card."/>
    <type value="Resource"/>
  </parameter>
  <parameter>
    <name value="NewCoverage"/>
    <use value="in"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="Parameter submitted by the new plan **SHALL** contain Coverage details of new or prospective health plan coverage provided by the new health plan based upon the member&#39;s enrollment."/>
    <type value="Resource"/>
  </parameter>
  <parameter>
    <name value="MemberPatient"/>
    <use value="out"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="Parameter returned by the old plan resource **SHALL** contain the MemberPatient resource received from new plan with the ADDITION of an identifier of type &quot;UMB&quot; representing the unique identifier identifying the member of the old health plan."/>
    <type value="Resource"/>
    <referencedFrom>
      <source value="NewCoverage"/>
      <sourceId value="beneficiary"/>
    </referencedFrom>
  </parameter>
  <parameter>
    <name value="NewCoverage"/>
    <use value="out"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="Parameter returned by the old plan resource **SHALL** contain the NewCoverage record received from the new plan."/>
    <type value="Resource"/>
  </parameter>
</OperationDefinition>