This page is part of the Da Vinci Payer Data Exchange (v2.0.0: STU2) 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

PDex Implementation Guide

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Official URL: http://hl7.org/fhir/us/davinci-pdex	Version: 2.0.0
NPM package name: hl7.fhir.us.davinci-pdex	ComputableName: DaVinciPayerDataExchange
Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

• XML
• JSON

Cross Version Analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (hl7.fhir.us.davinci-pdex.r4) and R4B (hl7.fhir.us.davinci-pdex.r4b) are available.

IG Dependencies

This IG Contains the following dependencies on other IGs.

Package hl7.fhir.us.udap-security#0.1.0 This implementation guide describes how to extend OAuth 2.0 to support secure and scalable workflows for business-to-business (B2B) apps that implement the client credentials flow or authorization code flow. (built Fri, Aug 6, 2021 15:57+0000+00:00)

Package hl7.fhir.us.davinci-hrex#1.0.0 The Da Vinci Payer Health Record exchange (HRex) Framework/library specifies the FHIR elements used in multiple Da Vinci implementation guides. This includes FHIR profiles, functions, operations, and constraints on other specifications such as CDS-Hooks and other aspects of Da Vinci Use Cases that are common across more than a single use case. Da Vinci HRex Implementation Guide (IG) will make use of US Core profiles that are based on the FHIR R4 specification wherever practical. The HRex IG will use the HL7 FHIR Release 4/US Core STU3 specification as its base but will provide additional guidance and documentation to support implementations that follow the HL7 FHIR STU3/US Core STU2 and HL7 FHIR DSTU2/Argonaut specifications. The HRex profiles documented in this IG will be used to exchange data between providers systems (e.g. EHRs) and other providers, payers, and third-party applications where appropriate. In addition, exchanges from payer systems to providers, other payers, and third-party applications are supported by the HRex profiles and operations. HRex may define new extensions, profiles, value sets, constraints/extension to other specification (e.g. specific CDS-Hooks) that are specific Da Vinci requirements. Where appropriate these Da Vinci specific artifacts will be promoted for incorporation into the future versions of existing standards (e.g. R4 US Core profiles) and deprecated in this guide on publication in the updated standard. (built Wed, Mar 23, 2022 18:55+0000+00:00)

Package hl7.fhir.uv.extensions.r4#1.0.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)

Package hl7.fhir.r4.examples#4.0.1 Example resources in the R4 version of the FHIR standard

Package hl7.fhir.uv.sdc#3.0.0 The SDC specification provides an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR. This includes two components: * Support more sophisticated questionnaire/form use-cases such as those needed for research, oncology, pathology and other clinical domains. *Support pre-population and auto-population of EHR data into forms/questionnaires for uses outside direct clinical care (patient safety, adverse event reporting, public health reporting, etc.). (built Tue, Mar 8, 2022 18:32+0000+00:00)

Package hl7.fhir.us.davinci-crd#2.0.0 Guidelines for conveying coverage requirements to clinicians when planning treatment (built Fri, Oct 20, 2023 14:06+0000+00:00)

Package hl7.fhir.uv.subscriptions-backport.r4#1.1.0 The Subscription R5 Backport Implementation Guide enables servers running versions of FHIR earlier than R5 to implement a subset of R5 Subscriptions in a standardized way. (built Wed, Jan 11, 2023 15:34+1100+11:00)

Package hl7.fhir.us.davinci-pas#2.0.1 Guidelines for conveying coverage requirements to clinicians when planning treatment. (built Fri, Dec 1, 2023 20:39+0000+00:00)

Global Profiles

There are no Global profiles defined

Copyrights

This publication includes IP covered under the following statements.

• All X12 products are subject to this IP policy, including published and draft works.X12 is the only organization authorized to grant permission for use of X12 products. Users of all X12 products should make sure that they understand the permissible uses, as well as the limitations on such usage, as outlined below.Additional IP information can be found here Send an email to ip@x12.org to request permission to reproduce X12 IP. Include your name, organization, title, address, city, state, zip, email, a detailed description of the Submitted Artifact, including the underlying or cited X12 Product, and a detailed description of the intended audience and planned distribution method for the Artifact.Additional information on X12 licensing program can be found here To purchase code list subscriptions call (425) 562-2245 or email admin@wpc-edi.com.
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  • X12 Claim Adjustment Reason Codes: PdexPriorAuthorization and X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes
• All X12 work products are copyrighted. Any use of any X12 work product must be compliant with US Copyright laws and X12 Intellectual Property policies.Please see https://x12.org/products/licensing-program
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  • X12 Service Type Codes: ExplanationOfBenefit/PDexPriorAuth1, PdexPriorAuthorization and PriorAuthServiceTypeCodes
• CMS maintains HIPPS. There are no known constraints on the use of HIPPS.
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  • Health Insurance Prospective Payment System (HIPPS): ExplanationOfBenefit/PDexPriorAuth1, PDexPAInstitutionalProcedureCodes, PDexPAInstitutionalProcedureCodesVS and PdexPriorAuthorization
• Copyright HL7. Licensed under creative commons public domain
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  • identifierType: Bundle/1000000-1, Bundle/1000000-2... Show 4 more, Bundle/1000000-3, Patient/1, Patient/1-2 and Patient/100
• HL7 Inc.
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  • Claim Type Codes: ExplanationOfBenefit/PDexPriorAuth1
• 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
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  • ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code: AssociatedServers, BundleTypeVS... Show 86 more, ContactPointAvailableTime, CredentialStatusCS, DaVinciPayerDataExchange, DispenseRefill, DynamicRegistration, EndpointAccessControlMechanism, EndpointAccessControlMechanismCS, EndpointAccessControlMechanismVS, EndpointConnectionTypeCS, EndpointConnectionTypeVS, EndpointConnectionTypeVersion, EndpointConnectionTypeVersionCS, EndpointConnectionTypeVersionVS, EndpointFhirMimeTypeCS, EndpointFhirMimeTypeVS, EndpointHieSpecificConnectionTypeCS, EndpointPayloadTypeCS, EndpointPayloadTypeVS, EndpointRank, EndpointUsecase, ExplanationOfBenefit_Identifier, ExplanationOfBenefit_Patient, ExplanationOfBenefit_ServiceDate, ExplanationOfBenefit_Type, ExplanationOfBenefit_Use, FDANationalDrugCode, FhirIg, IdentifierStatus, IdentifierStatusVS, IdentifierTypeCS, LevelOfServiceCode, MtlsBundle, MtlsEndpoint, MtlsObjectCodeCS, MtlsObjectType, MtlsOrganization, MtlsSignedObject, NdhAssociatedServersTypeCS, NdhAssociatedServersTypeVS, NdhFhirEndpointUseCaseCS, NdhFhirEndpointUseCaseVS, NdhSecureExchangeArtifactsCS, NdhSecureExchangeArtifactsVS, NdhVerificationStatusCS, NdhVerificationStatusVS, OrgTypeCS, OrgTypeVS, PDexAdjudication, PDexAdjudicationCS, PDexAdjudicationCategoryDiscriminator, PDexAdjudicationDiscriminator, PDexIdentifierType, PDexPAInstitutionalProcedureCodes, PDexPAInstitutionalProcedureCodesVS, PDexPayerAdjudicationStatus, PDexPayerBenefitPaymentStatus, PDexProviderExportModeVS, PDexSupportingInfoType, PdexDevice, PdexMedicationDispense, PdexMedicationDispensePatient, PdexMedicationDispenseStatus, PdexPriorAuthorization, PdexProviderExportModeCS, PdexServerCapabilityStatement, PriorAuthServiceTypeCodes, PriorAuthorizationAmounts, PriorAuthorizationUtilization, PriorAuthorizationValueCodes, Provenance, ProvenanceAgentRoleType, ProvenanceAgentType, ProvenancePayerDataSource, ProvenancePayerSourceFormat, ProvenanceSourceFrom, ReviewAction, ReviewActionCode, SecureExchangeArtifacts, TrustFramework, TrustFrameworkTypeCS, TrustFrameworkTypeVS, TrustProfileCS, TrustProfileVS, VerificationStatus, X12278ReviewDecisionReasonCode and X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes
• These codes are excerpted from ASTM Standard, E1762-95(2013) - Standard Guide for Electronic Authentication of Health Care Information, Copyright by ASTM International, 100 Barr Harbor Drive, West Conshohocken, PA 19428. Copies of this standard are available through the ASTM Web Site at www.astm.org.
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  • Signature Type Codes: Bundle/example-mtls-endpoint-bundle
• This CodeSystem is not copyrighted.
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  • PDex Adjudication Codes: PDexAdjudication, PDexAdjudicationCategoryDiscriminator and PdexPriorAuthorization
  • PDex Adjudication Discriminator: PdexPriorAuthorization
  • PDex Payer Adjudication Status: PDexPayerBenefitPaymentStatus
  • PDex Supporting Info Type: PDexSupportingInfoType
• This is an example set based on ASTM Standard, E1762-95 (2013) HL7 RoleClass OID 2.16.840.1.113883.5.110, HL7 Role Code 2.16.840.1.113883.5.111, HL7 ParticipationType OID: 2.16.840.1.113883.5.90, HL7 ParticipationFunction codes at OID: 2.16.840.1.113883.5.88, and HL7 Security and Privacy Domain Analysis Model roles classes.
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  • Contract Signer Type Codes: Bundle/1000000-1, Bundle/1000000-2, Bundle/1000000-3 and Provenance/1000017
• This is an example set.
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  • Adjudication Value Codes: ExplanationOfBenefit/PDexPriorAuth1, PDexAdjudication and PdexPriorAuthorization
  • Example Diagnosis Type Codes: ExplanationOfBenefit/PDexPriorAuth1
  • Example Related Claim Relationship Codes: ExplanationOfBenefit/PDexPriorAuth1
  • Funds Reservation Codes: ExplanationOfBenefit/PDexPriorAuth1
  • Process Priority Codes: ExplanationOfBenefit/PDexPriorAuth1 and PdexPriorAuthorization
• This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
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  • LOINC: DocumentReference/123456
• 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®): Bundle/1000000-1, Bundle/1000000-2... Show 7 more, Bundle/1000000-3, Bundle/3000003, Device/543210, Encounter/6, Encounter/7, Encounter/8 and PdexDevice

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