This page is part of the Da Vinci Payer Data Exchange (v2.1.0: STU2.1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Change History

Page standards status: Informative

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STU 2.1.0-ballot Reconciliation

JIRA Ticket	Change
FHIR-50105	Clarify Asynchronous Response for Bulk Member Match
FHIR-49110	Optional inclusion of Financials in Provider Access API to support VBC use cases
STU 2.1 Block Vote 3
FHIR-48991	Fix broken Links and other issues identified in QA Report
FHIR-48922	$davinci-data-export param exportType should be mandatory
FHIR-48088	Code Systems should be in THO or be granted an exemption
FHIR-48079	Separate API details from the Data payload section
FHIR-48063	Member-authorized exchange is underspecified
FHIR-48061	"PDex Implementation, Actors, Interactions, Data Payloads and Methods" page important or redundant?
FHIR-48057	Missing must support definition
FHIR-48036	Separate data mapping and patient matching discussion
FHIR-48023	Sub-field must support language inconsistency
FHIR-47778	Include the full HRex privacy and security requirements
FHIR-47761	Security and Privacy and Access Permissions Page not accessible
FHIR-47562	Please add a "Plain Language Summary about HL7 and this Guide" to the home page.
FHIR-47056	Clarify OAuth2.0 workflow for Payer to Payer
FHIR-47053	Require MemberId parameter to be returned in $member-match
STU 2.1 Block Vote 2
FHIR-48701	AppointmentBook hook usage for Provider Access use case
FHIR-48313	What are implementers supposed to follow for exportType
FHIR-48077	provenance details are spread across several pages and are inconsistently linked
FHIR-48073	Use Case Scenarios page not easily reachable
FHIR-48072	Data Mapping Conformance Requirements
FHIR-48070	integrate separate sections on data mapping
FHIR-48058	Unclear references to Da Vinci ATR
FHIR-48037	CapabilityStatements don't belong under Data Mapping
FHIR-47057	Don't require mapping claims data to US Core resources if sending as ExplanationOfBenefit resources
FHIR-47055	Don't require five year time limit on bulk Payer to Payer exchange
FHIR-47054	Make saving Provenance information received through Payer to Payer optional
FHIR-46761	Add Prev / bottom / Next to header/footer
STU 2.1 Block Vote 1
FHIR-48675	Add Hyperlink to PDex Server Capability Statement
FHIR-48369	Conflicting statements on OAuth-authorized exchange
FHIR-48076	With Mod: Remove superseded CDS Hooks page
FHIR-48074	With Mod: provider-controlled information requests and filtering page not easily reachable
FHIR-48056	With Mod: Multiple CapabilityStatement descriptions not in sync and should be collapsed
FHIR-47794	Change SHOULD to SHALL
FHIR-47792	rewrite for clarity and grammar
FHIR-47789	Not Persuasive: Change SHOULD to SHALL
FHIR-47787	Clarify concept of changed status
FHIR-47786	Change SHOULD to SHALL
FHIR-47785	Change SHOULD to SHALL
FHIR-47784	Confusing Phrase
FHIR-47783	Clarify the Regulatory requirements
FHIR-46681	Add US Core 7.0.0 support to the IG
STU 2.1 Technical Corrections
TC:FHIR-48071	Rendered text in the middle of example json
TC:FHIR-48068	Reference to profile pages instead of data mapping pages
TC:FHIR-48067	mebedded -> embedded
TC:FHIR-48065	member health history us core sections should be subsections
TC:FHIR-48040	device row in capability statement table shifted over incorrectl
TC:FHIR-48039	un-rendered link on the capability statement page
TC:FHIR-48024	Incorrect Section Numbering
TC:FHIR-48022	Oral Basis Profile is the Dental Profile?
TC:FHIR-47973	Large number of technical corrections
TC:FHIR-47788	grammatical errors and typos

STU 2.1.0 Update

JIRA Ticket	Change
TC:FHIR-46479	Change CARIN Blue Button IG link to 2.1.0-snapshot1
FHIR-46476	Provide guidance on handling of unstructured data for exchange via Payer-to-Payer API
FHIR-45992	Overview page should mention different APIs instead of exchange methods
FHIR-42964 FHIR-43375	Add more Clarity to Step 3- Request Access token for Member Access , How to communicate the Patient ID or Member id when Request Access token for Member Access
FHIR-45969	Specify a means to search for different types of groups.
FHIR-46444	Add Endpoint discovery expectations to index.html
Add links to C4BB Basis Profiles for use in Payer and PRovider APIs	Point to C4BB Basis (Non-Financial) Profiles to enable EOBs to be exchanged via Provider Access and Payer-to-Payer API. Update relevant narrative pages.
Updates from CMS Connectathon 2024-07-17	Add comment about search parameters for _tchangehistory.mdypeFilter. Re-work introduction page to Explain the differences between the different APIs. Patient, Provider and Payer-to-Payer. Change Order Select to Encounter Start in Provider Access API Section. CDS Hooks. Should this be retired? Note to say it pre-dates CMS Regulations. Add scope for Single-member match add 6.4.6 to single-member match and change the scope to fit. Re-order Table of Contents - PDex IG not before introduction.
Updates from PDex community meeting 2024-07-12	Use rendering provider NPI as minimum for Attribution Lists. Add EMR Role-based security Assumption. Add UDAP subject_id recommendation.
FHIR-45353	Capturing adjudication (determination) date for pre-auth. Created WhenAdjudicated Extension to hold a DateTime element that can be used in EOB item.adjudication and adjudication.
FHIR-46132	Define Consent Profile for Provider Access Opt-out. Make clear it is optional and provided as assistance for recording opt-out
Identify Provider Access and Payer-to-Payer as Async APIs	Add section to Payer-to-Payer Bulk and Provider Access API narrative pages to use HTTP POST and operate as Async Operations
Add new Data Payload section	Add Data Payload section to Provider Access Narrative and Payer-to-Payer bulk API narrative.
Add new Capability Statements	Add capability Statements for Provider Access and Payer-to-Payer API access.
Fix Payer-to-Payer bulk exchange workflow digram	Change from $pdex-p2p-export to $davinci-data-export
More specific Group.code value for Operation Scope	More specific Group.code value using CodeSystem URL for Operation Scope
Edited Scopes for Operations	Edited scopes for Operations used in Payer-to-Payer and Provider Access APIs
Added Informative Extension to Pages	Added Informative Extension to Pages in Sushi-config.yaml
Added Change History to Menu	Add Change History page to Menu
FHIR-45364	Provide Use case examples for use of custom extensions in PDex Provider Group
Update Clinical-Financial picture in overview.md	Update Clinical Financial image on overview page.
FHIR-45356	Change milsEndpoint examples to use correct code from NdhAssociatedServersTypeCS
FHIR-45355	Removed copied NDH Extensions, Code Systems and Value Sets. Point to content in NDH 1.0.0-ballot, allowing replicated content to be removed from PDex.
FHIR-45352	Added support for US Core 6.1.0 in addition to US Core 3.1.1. Based on L McKenzie Publishing Guidance
New MembersOptedOut Extension	Extension to capture number of Attributed Members excluded from the list through Opt-Out
TC: FHIR-44906	Fix broken link to Bulk Data Access IG
Add DaVinci-data-export-operation to Other-igs.md	Add link to Da Vinci Data Export Operation in other-igs.md
Expand narrative for Provider Access and Payer-to-Payer APIs	Removed ExportModeVS and ExportModeCS, replaced by exportType with fragment
FHIR-44807	Drop Must Support from item.adjudication[consumeUnits] In PDex Prior Authorization
Add Provider Access API Diagram	Created Plantuml for Provider Access API
Decision to remove optout members from Group	Remove OptOut Extension
Define OptedOut Extension to capture member optout	Added OptedOut Extension to PDexProviderGroup to record member opt out from data sharing with attributedproviders

STU 2.0.0-ballot:Ballot Reconciliation

JIRA Ticket	Change
Payer-to-Payer Bulk Exchange Draft	Draft of PDex Multi Member Match Operation and Request and Response Bundles
BallotRec-Vote7
TC: endpoint example	Update Endpoint example with new Trust Framework certificates in Base64Binary
TC: FHIR-41675	Remove duplicate codes from Provenance Agent Type
TC: FHIR-41497	Missing reference to CDS Hooks diagram
TC: FHIR-41399	Text states "US Core v3.1.1" but URL behind "US Core FHIR R4" points to US Core V 6.0.0
TC: FHIR-41398	Typo at the bottom of section 5.0.4.3 ("4.2" vs. "5.2")
FHIR-41381	Add narrative stating that the Prior Authorization profile also applies to the Payer to Payer use case
NDH Profiles and Extensions	Imported unpublished NDH Profiles, Extensions, CodeSystems and ValueSets into PDex for mTLS support
FHIR-41307	Conflicting Links to HRex Coverage Profile
FHIR-41177	Capturing adjudication (determination) date for pre-auth
FHIR-40517	Section numbering is broken
Created Examples for mTLS	Created Examples for MtlsOrganization and MtlsEndpoint
FHIR-40357	Possible typo in Data Mapping specification
FHIR-40239	Missing endpoint URLs?
FHIR-36626	Review all mappings as significant errors have been detected - Reviewed against CARIN-BB STU2
FHIR-36602	Review all mappings as significant errors have been detected in the above mappings and are expected in other mappings.- Reviewed against CARIN-BB STU2
FHIR-36601	Review all mappings for DiagnosticReport - Reviewed against CARIN-BB STU2
FHIR-36598	Review all mappings for Encounter - Reviewed against CARIN-BB STU2
QA Report Fixes	Apply fixes to resolve QA Report Errors.
TC: FHIR-39434	Update table of profiles for payer-to-payer exchange
FHIR-39424	We need a new OperationDefinition for patient-export-pdex
FHIR-39314	Need detail w.r.t. reconciling new session with Consent from earlier interaction
FHIR-36626	Review all mappings as significant errors have been detected - fixed table layout and reconcile to CARIN-BB STU2 - CareTeam, Condition, Coverage, Encounter
BallotRec-Vote6
TC: FHIR-38767	Typo in 5.2.1.3 Future Direction for Discovery and Registration
FHIR-38708	Clarification on payer directory queries
FHIR-38707	Clarifications on dynamic client registration and first token request
FHIR-38706	Consent reference to DocumentReference in member match request clarification -
TC: FHIR-38705	Endpoint bundle example is not valid
TC: FHIR-38696	Wrong link - NationalDirectory Endpoint resource
FHIR-38650	PDex defines an incorrect request pattern for Patient-level bulk export
FHIR-38097	ExplanationOfBenefit description clarification for use of item level, header level adjudication
BallotRec-Vote5
FHIR-38096	For Pdex Prior Authorization EOB, reviewAction extension not available at header level adjudication.
FHIR-37904	Add Privacy and Security section to IG
FHIR-36598	Review all mappings for Encounter.
FHIR-36495	CDS Card should not return an access token
FHIR-36315	Unclear definitions of filtering vs restricting cases
TC: FHIR-36174	Correction in StructureDefinition-pdex-provenance
BallotRec-Vote4
Added mTLS Discovery Profiles	Added mTLS Discovery profiles and referenced in Payer-to-Payer Exchange page.
FHIR-37778	Link to the HREX Coverage takes you to the Patient Demographic Profile
FHIR-37645	Consent presentation for P2P
FHIR-37644	Consent Revocation for P2P
FHIR-36599	Review 835 and all mappings to diagnostics.
FHIR-36572	Create a Formal Specification or Conformance Expectations page/section
FHIR-36462	Incorrect Diagram, Consent considerations, everything operation (Duplicate of FHIR-36461)
FHIR-36254	Missing details of payer-to-payer mutual authentication
FHIR-36223	PDEX defined their own version of an already existing code system
TC: FHIR-36176	Correction needed in ExplanationOfBenefit-PDexPriorAuth1.json
FHIR-36078	CareTeam for a patient is not the same thing as "a random collection of Providers that treated the patient once"
BallotRec-Vote3
FHIR-37577	Change use of _profile to ExplanationOfBenefit.use to filter on "preauthorization"
FHIR-37576	Duplicate to FHIR-37577
FHIR-37546	Consent expiration for P2P Data Exchange
FHIR-36767	$member-match operation conformance not defined
FHIR-36629	change from are expected to SHALL
FHIR-36601	Review all mappings for DiagnosticReport (MedicationDispense).
FHIR-36462	Incorrect Diagram, Consent considerations, everything operation
BallotRec-Vote2
FHIR-36885	ExplanationOfBenefit.use = preauthorization
FHIR-36772	PDEX Provenance page. Broken section
FHIR-36767	$member-match operation conformance not defined
FHIR-36600	Review all mappings for Coverage
FHIR-36597	Invalid data population instruction for Condition
FHIR-36596	Invalid data population instruction for CareTeam
FHIR-36563	No issues; this section is dense but necessary in defining scope.
FHIR-36352	Expand CPCDS Undefined Acronym
FHIR-36337	Update Name Column for Lab Result
TC: FHIR-36075	Link to US Core 3.1.1 actually links to HL7 home
TC: FHIR-36314	Formatting fixes in Care Team element table
Ballot-Rec-Vote1
TC: FHIR-37366	Vital Signs not referenced in Capability Statement
FHIR-36603	Note that CPCDS is external and informative
FHIR-36580	Update references to HRex to published 1.0.0 version
TC: FHIR-36575	Make the CapabilityStatement rendering more reader friendly
FHIR-36573	Correction: Added pages to drop-down menu
TC: FHIR-36569	Create a Change Notes or History page
FHIR-36564	Add clarifying markup for CPCDS mapping tables
FHIR-36562	Add CARIN Acronym on first use
TC: FHIR-36255	Formatting issues for PDEX server capability statement
FHIR-36237	Sending Duplicative Data
TC: FHIR-36080	link to published FHIR v4.0.1
TC: FHIR-36079	removed double link to ChangeHistory

Technical Corrections are prefixed with "TC: "

STU 2.0.0

The following changes were applied in the Proposed STU 2.0.0 update:

JIRA Ticket	Change
TC: FHIR-36026	Multiple Technical Corrections
FHIR-35868	Revert US Core References back to 3.1.1
FHIR-34308	Update US Core and PDex inter-relationship diagram to add Prior Auth in Overview page.
FHIR-33382	Change references to US Core to link to the current 4.0.0 version. Reverted - see FHIR-35868 above.
FHIR-33218	Update Payer-to-Payer Exchange section to clarify use of Bulk FHIR protocols for retrieval of data for a single patient/member only. The flow has been subject to substantial assessment at multiple connectathons and test events.
FHIR-33217	Add a PDex Prior Authorization profile, based on the EOB resource to support the exchange of Prior Authorization information with Members. Added Slices to item adjudication and added consumedunits slice
FHIR-33141	Revert PDex Provenance Recorded definition to the US Core Provenance version
FHIR-33173	Add clarification to use of $everything operation - superceded by updates to Payer-to-Payer exchange
FHIR-33216	Add guidance for use of Consent resource in $member-match operation - superceded by updated to Payer-to-Payer exchange
FHIR-33713	Add Provenance custodian record for receipt of member data from prior payer

STU 1.0.0

First version of the PDex IG.

STU 0.1.0

Draft of PDex IG

STU 0.0.1

Skeleton version of PDex IG

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