Da Vinci Payer Data exchange Implementation Guide Release 0.1.0

This page is part of the Da Vinci Payer Data Exchange (v0.1.0: STU 1 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

2-2 Member Consent

Member/Patient Consent for scenarios covered in this Implementation Guide fall into two areas:

  1. Provider-Health Plan Exchange
  2. Member-mediated Information Exchange

2-2-1 Provider-Health Plan Exchange

Provider-Health Plan exchange of data is covered by the Health Insurance Portability and Accountability Act (HIPAA) under the Treatment Payment and Health Care Operations provision.

2-2-2 Member-mediated Information Exchange

The CMS Notice For Proposed Rule Making for Patient access and Interoperability requires that a subscriber to a new health plan SHALL be able to request their information to be passed from their old health plan to their new health plan.

A Member SHALL also be able to use APIs to share information with Third Party Applications. This includes:

  • Their health history
  • Healthcare network/directory information
  • Pharmacy network/directory information
  • Prescription Drug Formulary information

The Member-mediated Information Exchange method will build upon established OAuth2.0 protocols for patient access to their health and claims information that enables the sharing of information with third-party applications. The health history payload for the exchange would be the same FHIR resources that are passed to providers under the Provider-Payer exchange scenario.

The exchange of Healthcare network/directory information and Pharmacy network/directory information is covered in the PDex-plan-net IG. The exchange of Prescription drug formulary information is covered in the PDex-formulary IG.

The OAuth2.0-based exchange is covered in detail in Section 7