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Conforming to CDex Attachments

Page standards status: Trial-use

Introduction

CDex attachments are intended to be compatible with the X12n transactions and designed to work for both solicited and unsolicited claims and prior authorization. Refer to the CDex CapabilityStatements resources for conformance expectations for the various actors and roles. The tables below show:

• The CDex Attachments interaction for each role and the conformance resource and terminology that makes it unique to help clarify the different use cases.
• The optional and required capabilities for CDex Attachments transactions.
• The optional and required $submit-attachment Parameters

Systems may choose some or all of these capabilities and implement any combination of unsolicited or solicited attachments for prior authorization, claims, or both. Therefore, in contrast to the expectations in the CDex CapabilityStatements, they should define what they support in their local capability statement in one or more of the following ways:

1. (Preferred) Formally derived implementable profile from CDex Task Attachment Request Profile
2. Document their systems' capabilities for requesting attachments in CapabilityStatement.rest.resource.documentation for the Task resource.
3. (Preferred) Formal OperationDefinition derived from $submit-attachment
4. Document their systems' capabilities for submitting attachments in CapabilityStatement.rest.documentation

Provider Conformance

Provider in Role of Data Source Server

Data Source Server	Unsolicited Claims	Solicited Claims	Unsolicited Prior Authorization	Solicited Prior Authorization
CDex Task Attachment Request Profile	✘	✔	✘	✔
Task.reasonCode Terminology	-	claim	-	preauthorization

Provider in Role of Data Source Client

Data Source Client	Unsolicited Claims	Solicited Claims	Unsolicited Prior Authorization	Solicited Prior Authorization
Submit Attachment Operation	✔	✔	✔	✔
AttachTo parameter Terminology	claim	claim	preauthorization	preauthorization

Payer Conformance

Payer Data Consumer Server Role

Data Consumer Client	Unsolicited Claims	Solicited Claims	Unsolicited Prior Authorization	Solicited Prior Authorization
Submit Attachment Operation	✔	✔	✔	✔
AttachTo parameter Terminology	claim	claim	preauthorization	preauthorization

Payer Data Consumer Client Role

Data Consumer Server	Unsolicited Claims	Solicited Claims	Unsolicited Prior Authorization	Solicited Prior Authorization
CDex Task Attachment Request Profile	✘	✔	✘	✔
Task.reasonCode Terminology	-	claim	-	preauthorization

✔: Conformance resource used in the transaction
✘: Conformance resource not used in the transaction

Capabilities for Requesting Attachments

Capability	Must Support*	Optional
Requesting Attachments Using Attachment Codes	✔
Requesting Attachments Using Questionnaire		✔
Signatures	✔
Representing The Purpose Of Use (POU) For The Requested Data		✔
Ability to submit attachments data in multiple submissions		✔

* See the next section

CDex Must Support Definition

The CDex Profile elements consist of Mandatory, Must Support, and Optional elements. Elements that are neither Mandatory or Must Support are Optional. Mandatory elements are elements with a minimum cardinality greater than 0. Must Support elements are marked with the mustSupport flag and SHALL be interpreted as follows:

Task Source

Data Source server where the Task is stored and updated, or Data Consumer client that POST the Task to Data Source server.

Task Consumer

Data Consumer client receiving a Task from the Data Source server due to a FHIR interaction.

• If the minimum cardinality of an element is greater than 0, the element is required and the Task Source SHALL populating the data element with value unless:
  • The profile references a dataAbsentReason (DAR) extension, then the Task Source SHALL use that extension to communicate the reason for missing data.
• If the minimum cardinality of an element is equal to 0, the Task Source SHALL be capable of populating the data element when sharing Task compliant with a CDex profile. Therefore, the system must demonstrate the population and sharing of the element. However, it is acceptable to omit the element if the system doesn't have values in a particular instance. A system that is incapable of ever sharing the the element would be non-conformant.
• The Task Consumer SHALL be capable of processing Task instances containing the data elements without generating an error or causing the application to fail.

NOTE: mustSupport indicates what Da Vinci CDex conformant systems are expected to be able to handle. Systems are free to include additional data - and receivers SHOULD NOT reject instances that contain unexpected data elements if those elements are not modifier elements. However, the Task Source should be aware that they can't count on the Task Consumer storing, processing, or doing anything other than ignoring data that is not marked as mustSupport.

$submit-attachment Parameters for Sending Attachments

Parameter	Required	Optional
TrackingId	✔
AttachTo	✔(see above)
PayerId		✔
OrganizationId	✔
ProviderId	✔
MemberId	✔
ServiceDate	✔(claims)	✔(prior authorization)
Attachment.LineItem		✔
Attachment.Code		✔(It SHOULD be present when submitting unsolicited attachments)
Attachment.Content	✔(DocumentReference, QuestionnaireResponse if support Requesting Attachments Using Questionnaire	✔(Servers SHOULD support other FHIR types)
Attachment.Final		✔