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. For a full list of available versions, see the Directory of published versions
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Other Implementation Guides
An important objective in the HL7 Da Vinci Accelerator Project is to avoid
unnecessary profile proliferation and to leverage common processes. To this end
the PDex IG leverages the profiles, extensions and operations incorporated into
other Implementation Guides.
Implementation Guides
PDex references the following Implementation Guides:
Note: The FAST National Directory (NDH) IG has yet to be published. To enable PDex to leverage the profiles and extensions in the NDH IG the required Profiles, Extensions, Value Sets and Code Systems have been copied into PDex. Once the NDH IG is published it is intended that the PDex IG would remove the NDH content in a future PDex STU update and reference the FAST NDH IG directly.
Profiles
The following profiles are referenced in this IG:
US Core
Health Record Exchange (HRex)
Da Vinci Member Attribution (ATR)
Operations
The following operations are referenced:
Health Record Exchange (HRex)
Da Vinci Member Attribution (ATR)
NOTE: exportType parameter SHALL be populated with a value for all PDex implementations of the $Davinci-data-export-operation.
i.e., Provider Access API and Payer-to-Payer Bulk API.
IG/package dependencies
The following dependencies are used in production of this guide:
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.
IP Statements
This publication includes IP covered under the following statements.
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- 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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- CMS maintains HIPPS. There are no known constraints on the use of HIPPS.
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- 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, BulkMemberMatch... Show 81 more, ContactPointAvailableTime, DaVinciPayerDataExchange, DispenseRefill, DynamicRegistration, EndpointAccessControlMechanism, EndpointPayloadTypeCS, EndpointPayloadTypeVS, EndpointRank, EndpointUsecase, ExplanationOfBenefit_Identifier, ExplanationOfBenefit_Patient, ExplanationOfBenefit_ServiceDate, ExplanationOfBenefit_Type, ExplanationOfBenefit_Use, FDANationalDrugCode, FhirIg, Group_Code, IdentifierStatus, LastFilters, LastTransmission, LastTypes, LevelOfServiceCode, MatchParameters, MembersOptedOut, MtlsBundle, MtlsEndpoint, MtlsObjectCodeCS, MtlsObjectTypeVS, MtlsOrganization, MtlsSignedObject, OrgTypeCS, OrgTypeVS, PDexAdjudication, PDexAdjudicationCategoryDiscriminator, PDexAdjudicationDiscriminator, PDexIdentifierType, PDexMemberMatchGroup, PDexMemberNoMatchGroup, PDexMultiMemberMatchRequestParameters, PDexMultiMemberMatchResponseParameters, PDexMultiMemberMatchResultVS, PDexPAInstitutionalProcedureCodes, PDexPAInstitutionalProcedureCodesVS, PDexPayerAdjudicationStatus, PDexPayerBenefitPaymentStatus, PDexProviderGroup, PDexProviderSharingConsent, PDexServerCapabilityStatement61, PDexSupportingInfoType, PDexSupportingInfoTypeCS, PdexDevice, PdexMedicationDispense, PdexMedicationDispensePatient, PdexMedicationDispenseStatus, PdexMemberAttributionCS, PdexMultiMemberMatchResultCS, PdexPayerAccessServerCapabilityStatement, PdexPriorAuthorization, PdexProviderAccessServerCapabilityStatement, PdexServerCapabilityStatement, PriorAuthServiceTypeCodes, PriorAuthorizationAmounts, PriorAuthorizationUtilization, PriorAuthorizationValueCodes, Provenance, ProvenanceAgentRoleType, ProvenanceAgentType, ProvenancePayerDataSource, ProvenancePayerSourceFormat, ProvenanceSourceFrom, ReviewAction, ReviewActionCode, SecureExchangeArtifacts, TrustFramework, TrustFrameworkTypeCS, TrustFrameworkTypeVS, TrustProfileCS, VerificationStatus, WhenAdjudicated, 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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- This CodeSystem is not copyrighted.
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- 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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- 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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- 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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- This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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- Adjudication Value Codes: ExplanationOfBenefit/PDexPriorAuth1, PDexAdjudication and PdexPriorAuthorization
- Claim Type Codes: ExplanationOfBenefit/PDexPriorAuth1
- Condition Category Codes: Bundle/3000003
- Condition Clinical Status Codes: Bundle/3000003
- ConditionVerificationStatus: Bundle/3000003
- Consent Action Codes: Consent/consent-2, Consent/no-consent-1, PDexProviderSharingConsent and Parameters/payer-multi-member-match-in
- Consent PolicyRule Codes: Consent/no-consent-1 and PDexProviderSharingConsent
- Consent Scope Codes: Consent/consent-2, Consent/no-consent-1, PDexProviderSharingConsent and Parameters/payer-multi-member-match-in
- Coverage Class Codes: Coverage/coverage-2 and Parameters/payer-multi-member-match-in
- DataAbsentReason: Bundle/example-mtls-endpoint-bundle, MtlsEndpoint... Show 4 more, PDexPAInstitutionalProcedureCodes, PDexPAInstitutionalProcedureCodesVS, Payer-Payer Exchange and PdexPriorAuthorization
- Endpoint Connection Type: Bundle/example-mtls-endpoint-bundle, MtlsEndpoint and Payer-Payer Exchange
- Example Diagnosis Type Codes: ExplanationOfBenefit/PDexPriorAuth1
- Example Related Claim Relationship Codes: ExplanationOfBenefit/PDexPriorAuth1
- Funds Reservation Codes: ExplanationOfBenefit/PDexPriorAuth1
- Organization type: DiamondOnyxHealth
- Process Priority Codes: ExplanationOfBenefit/PDexPriorAuth1 and PdexPriorAuthorization
- Professional Credential Status: IdentifierStatus
- Provenance participant type: Bundle/1000000-1, Bundle/1000000-2... Show 14 more, Bundle/1000000-3, Bundle/3000003, Consent/consent-2, Consent/no-consent-1, PDexProviderSharingConsent, Parameters/payer-multi-member-match-in, Provenance, Provenance/1000002, Provenance/1000003, Provenance/1000004, Provenance/1000005, Provenance/1000006, Provenance/1000101 and ProvenanceAgentType
- SubscriberPolicyholder Relationship Codes: Coverage/883210, Coverage/Coverage1, Coverage/coverage-2, Coverage/coverage-link-2 and Parameters/payer-multi-member-match-in
- identifierType: Bundle/1000000-1, Bundle/1000000-2... Show 21 more, Bundle/1000000-3, Coverage/883210, Coverage/Coverage1, Coverage/coverage-2, Coverage/coverage-link-2, Group/example-pdex-member-consent-constraint-group, Group/example-pdex-member-no-match-group, Matched Members, Parameters/payer-multi-member-match-in, Parameters/payer-multi-member-match-out, Patient/1, Patient/1-2, Patient/100, Patient/1001, Patient/2002, Patient/patient-2, Payer 1, Payer 2, Practitioner/4, Provider 1 and Provider 2
- ActCode: Bundle/1000000-1, Bundle/1000000-2... Show 12 more, Bundle/1000000-3, Bundle/2000002, Bundle/3000002, Consent/consent-2, Consent/no-consent-1, Encounter/6, Encounter/7, Encounter/8, MedicationDispense/1000001, PDexProviderSharingConsent, Parameters/payer-multi-member-match-in and PdexMedicationDispense
- ActReason: Provenance/1000101
- DataOperation: Provenance/1000101
- NullFlavor: Bundle/1000000-1, Bundle/1000000-2... Show 4 more, Bundle/1000000-3, Patient/1, Patient/1-2 and Patient/100
- ParticipationType: Consent/consent-2 and Parameters/payer-multi-member-match-in
- Used by permission of HL7 International, all rights reserved Creative Commons License
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- US Core DocumentReferences Category Codes: DocumentReference/123456
- US Core Provenance Participant Type Extension Codes: Bundle/1000000-1, Bundle/1000000-2... Show 8 more, Bundle/1000000-3, Bundle/3000002, Provenance, Provenance/1000001, Provenance/1000016, Provenance/1000017, Provenance/1000101 and ProvenanceAgentType
- Endpoint Payload Types Code System: EndpointPayloadTypeVS
- mTLS Object Type Code: MtlsObjectTypeVS, MtlsSignedObject and Payer-Payer Exchange
- Organization Type: Acme of CT and OrgTypeVS
- PDex Provider Access API Attribution Code System: Attributed List of Health Plan Members for Practitioner 1122334455., PDexMemberMatchGroup, PDexMemberNoMatchGroup, PDexMultiMemberMatchResultVS and PDexProviderGroup
- PDex Multi-Member Match Result Code System: Group/example-pdex-member-consent-constraint-group, Group/example-pdex-member-no-match-group... Show 6 more, Matched Members, PDexMemberMatchGroup, PDexMemberNoMatchGroup, PDexMultiMemberMatchResultVS, PDexProviderGroup and Parameters/payer-multi-member-match-out
- Prior Authorization Values: ExplanationOfBenefit/PDexPriorAuth1, PdexPriorAuthorization and PriorAuthorizationAmounts
- Provenance Roles: Provenance and ProvenanceAgentType
- Provenance Payer Data Source Format: Bundle/1000000-1, Bundle/1000000-2... Show 13 more, Bundle/1000000-3, Bundle/3000002, Bundle/3000003, Provenance, Provenance/1000001, Provenance/1000002, Provenance/1000003, Provenance/1000004, Provenance/1000005, Provenance/1000006, Provenance/1000016, ProvenancePayerSourceFormat and ProvenanceSourceFrom
- Trust FrameworkType Code System: TrustFramework and TrustFrameworkTypeVS
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