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

3-2 Exchange Interactions

The PDex IG is specifying three exchange interactions:

  1. Providers and Health Plans (payers) exchanging information about the Member that a provider is caring for (P2HPX).
  2. Health Plans via a Member authorized exchange when a Member has moved from enrollment in one health plan to another health plan (MauthHPX).
  3. Health Plans and Third Party Applications that a Member has authorized to share the health information held by the health plan.

Two subsidiary Payer Data exchange Implementation Guides address the Member-authorized sharing of Health Plan information with Third Party Applications (Mauth3PX):

  • Healthcare Network Directory.
  • Pharmacy Network Directory.
  • Prescription Drug Formulary.

These subsidiary IGs are:

  • Payer Data exchange Plan Network Directory (PDex-plan-net) IG covering Healthcare and Pharmacy networks: http://hl7.org/fhir/us/davinci-pdex-plan-net/2019Jun/
  • Payer Data exchange Drug formulary (PDex-formulart) IG covering prescription drug formulary: http://hl7.org/fhir/us/davinci-pdex-formulary/2019Jun/