This page is part of the Da Vinci Payer Data Exchange (v0.1.0: STU 1 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions
3-6-6 US Core Practitioner
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Section Guide:
- Implementation...
- - Actors
- - Exchange Interactions
- - Data Payloads
- - Interaction Methods
- - Interaction and Payload Matrix
- - Data Mapping
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The US Core Practitioner profile SHALL be used to record information about Practitioners.
The essential fields to be provided in the US Core Practitioner resource are:
| R4 Hierarchical Name | R4 Name | Card. | Type |
|---|---|---|---|
| Practitioner | Practitioner | 0..* | |
| Practitioner.id | id | 0..1 | id |
| Practitioner.identifier | identifier | 1..* | Identifier |
| Practitioner.identifier.system | system | 1..1 | uri |
| Practitioner.identifier.value | value | 1..1 | string |
| Practitioner.name | name | 1..1 | HumanName |
| Practitioner.name.family | family | 1..1 | string |
| Practitioner.qualification.code | code | 1..1 | CodeableConcept |
3-6-6-1 Health Plan Mapping Assistance
A collaboration of Health Plan experts have performed an evaluation of claims information and developed a mapping of data for Members to the US Core Practitioner profile. This is shown below as an assistance to implementers:
| Line | PayerSourceRecord | CMS BB 2.0 Field | Data Descriptor | FHIR Profile | Profile Field | ValueSet | Notes |
|---|---|---|---|---|---|---|---|
| 1.1 | Claim-Provider | Claim billing provider NPI | US Core Practitioner | .identifier.value | |||
| 3.1 | Claim-Provider | Claim attending physician NPI | US Core Practitioner | .identifier.value | |||
| 6.1 | Claim-Provider | Claim referring provider NPI | US Core Practitioner | .identifier.value | |||
| 8.1 | Claim-Provider | Claim performing provider NPI | US Core Practitioner | .identifier.value | |||
| 10.1 | Claim-Provider | Claim operating physician NPI | US Core Practitioner | .identifier.value | |||
| 12.1 | Claim-Provider | Claim other physician NPI | US Core Practitioner | .identifier.value | |||
| 14.1 | Claim-Provider | Claim rendering physician NPI | US Core Practitioner | .identifier.value | |||
| 17.1 | Claim-Provider | Claim PCP | US Core Practitioner | .identifier.value |
Where an entry is provided in the CMS BB2.0 FIELD column the definition of the field can be reviewed using the following URL:
https://bluebutton.cms.gov/resources/variables/{CMS_BB2.0_FIELD}/
Where {CMS_BB2.0_FIELD} is replaced with the Field value in lower case. For example:
https://bluebutton.cms.gov/resources/variables/bene_id/ https://bluebutton.cms.gov/resources/variables/dob_dt/
3-6-6-2 Example Practitioner Resource
An example mapping of an Practitioner resource is shown here:
{
"resourceType" : "Practitioner",
"id" : "practitioner-1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated Narrative with Details
id: practitioner-1
meta:
identifier: 9941339108, 25456
name: Ronald Bone
address: 1003 Healthcare Drive Amherst MA 01002 (HOME)
</div>"
},
"identifier" : [
{
"system" : "http://hl7.org.fhir/sid/us-npi",
"value" : "9941339108"
},
{
"system" : "http://www.acme.org/practitioners",
"value" : "25456"
}
],
"name" : [
{
"family" : "Bone",
"given" : [
"Ronald"
],
"prefix" : [
"Dr"
]
}
],
"address" : [
{
"use" : "home",
"line" : [
"1003 Healthcare Drive"
],
"city" : "Amherst",
"state" : "MA",
"postalCode" : "01002"
}
]
}
Refer to the US Core Additional examples of the US Core R4 Implementation Guide for further examples of completed US Core Practitioner Profiles .
