Da Vinci Health Record Exchange (HRex)
1.0.0 - STU R1 US

This page is part of the Da Vinci Health Record Exchange (v1.0.0: STU1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: HRex Member Match Operation - XML Representation

Page standards status: Trial-use Maturity Level: 2

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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>$member-match</strong> operation allows one health plan to retrieve a unique identifier for a member from another health plan using a member's demographic and coverage information.  This identifier can then be used to perform subsequent queries and operations. Members implementing a deterministic match will require a match on member id or subscriber id at a minimum.  (I.e. A pure demographic match will not be supported by such implementations.)</p>
</div><p>URL: [base]/Patient/$member-match</p><p>Input parameters Profile: <a href="StructureDefinition-hrex-parameters-member-match-in.html">HRex Parameters - Member Match Request Profile</a></p><p>Output parameters Profile: <a href="StructureDefinition-hrex-parameters-member-match-out.html">HRex Parameters - Member Match Response Profile</a></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>Consent</td><td>1..1</td><td><a href="http://hl7.org/fhir/R4/resource.html">Resource</a></td><td/><td><div><p>Consent held by the system seeking the match that grants permission to access the patient information information on the system for whom a patient is sought.</p>
</div></td></tr><tr><td>IN</td><td>CoverageToMatch</td><td>1..1</td><td><a href="http://hl7.org/fhir/R4/resource.html">Resource</a></td><td/><td><div><p>Parameter that identifies the coverage to be matched by the receiving payer.  It contains the coverage details of health plan coverage provided by the member, typically from their health plan coverage card.</p>
</div></td></tr><tr><td>IN</td><td>CoverageToLink</td><td>0..1</td><td><a href="http://hl7.org/fhir/R4/resource.html">Resource</a></td><td/><td><div><p>Parameter that identifies the coverage information of the member as they are known by the requesting payer.  This information allows the matching payer to link their member coverage information to that of the requesting payer to ease subsequent exchanges, including evaluating authorization to share information in subsequent queries.  This parameter is optional as this operation may be invoked by non-payer systems.  However, it is considered 'mustSupport'.  If the client invoking the operation is a payer, they SHALL include their coverage information for the member when invoking the operation.</p>
</div></td></tr><tr><td>OUT</td><td>MemberIdentifier</td><td>1..1</td><td><a href="http://hl7.org/fhir/R4/datatypes.html#Identifier">Identifier</a></td><td/><td><div><p>This is the member identifier information for the patient as known by the server that is the target of the operation.</p>
</div></td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="2">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/davinci-hrex/ImplementationGuide/davinci-hrex"/>
      </extension>
    </valueInteger>
  </extension>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use">
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
        <valueCanonical
                        value="http://hl7.org/fhir/us/davinci-hrex/ImplementationGuide/davinci-hrex"/>
      </extension>
    </valueCode>
  </extension>
  <url
       value="http://hl7.org/fhir/us/davinci-hrex/OperationDefinition/member-match"/>
  <version value="1.0.0"/>
  <name value="MemberMatch"/>
  <title value="HRex Member Match Operation"/>
  <status value="draft"/>
  <kind value="operation"/>
  <date value="2022-03-23T18:57:57+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's demographic and coverage information.  This identifier can then be used to perform subsequent queries and operations. Members implementing a deterministic match will require a match on member id or subscriber id at a minimum.  (I.e. A pure demographic match will not be supported by such implementations.)"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <affectsState value="true"/>
  <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="CoverageToMatch"/>
      <sourceId value="beneficiary"/>
    </referencedFrom>
    <referencedFrom>
      <source value="CoverageToLink"/>
      <sourceId value="beneficiary"/>
    </referencedFrom>
  </parameter>
  <parameter>
    <name value="Consent"/>
    <use value="in"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="Consent held by the system seeking the match that grants permission to access the patient information information on the system for whom a patient is sought."/>
    <type value="Resource"/>
  </parameter>
  <parameter>
    <name value="CoverageToMatch"/>
    <use value="in"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="Parameter that identifies the coverage to be matched by the receiving payer.  It contains the coverage details of health plan coverage provided by the member, typically from their health plan coverage card."/>
    <type value="Resource"/>
  </parameter>
  <parameter>
    <name value="CoverageToLink"/>
    <use value="in"/>
    <min value="0"/>
    <max value="1"/>
    <documentation
                   value="Parameter that identifies the coverage information of the member as they are known by the requesting payer.  This information allows the matching payer to link their member coverage information to that of the requesting payer to ease subsequent exchanges, including evaluating authorization to share information in subsequent queries.  This parameter is optional as this operation may be invoked by non-payer systems.  However, it is considered 'mustSupport'.  If the client invoking the operation is a payer, they SHALL include their coverage information for the member when invoking the operation."/>
    <type value="Resource"/>
  </parameter>
  <parameter>
    <name value="MemberIdentifier"/>
    <use value="out"/>
    <min value="1"/>
    <max value="1"/>
    <documentation
                   value="This is the member identifier information for the patient as known by the server that is the target of the operation."/>
    <type value="Identifier"/>
  </parameter>
</OperationDefinition>