Da Vinci Payer Data Exchange
2.0.0-ballot - ballot
US
Da Vinci Payer Data Exchange
2.0.0-ballot - ballot
US
This page is part of the Da Vinci Payer Data Exchange (v2.0.0-ballot: STU2 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 
{
"resourceType" : "Bundle",
"id" : "1000000-1",
"meta" : {
"profile" : [
"http://hl7.org/fhir/StructureDefinition/Bundle"
]
},
"type" : "transaction-response",
"timestamp" : "2019-12-31T20:26:23.217+00:00",
"link" : [
{
"relation" : "self",
"url" : "https://example.com/base/fhir/Patient?ct=W2idG9rZW4iOiIrUklEOn53MThjQUk5RlVPZ0lEQUFBQUFBQU"
}
],
"entry" : [
{
"fullUrl" : "https://example.com/base/Patient/1",
"resource" : {
"resourceType" : "Patient",
"id" : "1",
"meta" : {
"lastUpdated" : "2019-07-07T13:26:22.0314215+00:00",
"profile" : [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient"
]
},
"language" : "en-US",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en-US\" lang=\"en-US\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"1\" Updated \"2019-07-07 01:26:22+0000\" (Language \"en-US\") </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/core/STU3.1/StructureDefinition-us-core-patient.html\">US Core Patient Profile</a></p></div><p><b>identifier</b>: Member Number: https://www.xxxhealthplan.com/fhir/memberidentifier#1234-234-1243-12345678901, Medical record number: 1234-234-1243-12345678901m, Health Plan Identifier: 1234-234-1243-12345678901u, Patient external identifier: 1234-234-1243-12345678901a</p><p><b>active</b>: true</p><p><b>name</b>: Johnny Appleseed </p><p><b>telecom</b>: ph: (443)555-1212, ph: (410)678-2323</p><p><b>gender</b>: male</p><p><b>birthDate</b>: 1986-01-01</p><p><b>address</b>: 123 Main Street Pittsburgh PA 12519 </p><p><b>maritalStatus</b>: unknown <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-NullFlavor.html\">NullFlavor</a>#UNK)</span></p></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MB"
}
]
},
"system" : "https://www.xxxhealthplan.com/fhir/memberidentifier",
"value" : "https://www.xxxhealthplan.com/fhir/memberidentifier#1234-234-1243-12345678901"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "MR"
}
]
},
"system" : "https://www.xxxhealthplan.com/fhir/medicalrecordnumber",
"value" : "1234-234-1243-12345678901m"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "XV"
}
]
},
"system" : "https://www.xxxhealthplan.com/fhir/uniquememberidentifier",
"value" : "1234-234-1243-12345678901u"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PT"
}
]
},
"system" : "https://www.xxxhealthplan.com/fhir/patacctnum",
"value" : "1234-234-1243-12345678901a"
}
],
"active" : true,
"name" : [
{
"family" : "Appleseed",
"given" : [
"Johnny"
]
}
],
"telecom" : [
{
"system" : "phone",
"value" : "(443)555-1212",
"rank" : 1
},
{
"system" : "phone",
"value" : "(410)678-2323",
"rank" : 2
}
],
"gender" : "male",
"birthDate" : "1986-01-01",
"address" : [
{
"type" : "physical",
"line" : [
"123 Main Street"
],
"city" : "Pittsburgh",
"state" : "PA",
"postalCode" : "12519"
}
],
"maritalStatus" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code" : "UNK"
}
]
}
},
"response" : {
"status" : "200"
}
},
{
"fullUrl" : "https://example.com/base/Encounter/6-1",
"resource" : {
"resourceType" : "Encounter",
"id" : "6-1",
"meta" : {
"lastUpdated" : "2019-07-14T19:26:23.217+00:00",
"profile" : [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"6-1\" Updated \"2019-07-14 07:26:23+0000\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/core/STU3.1/StructureDefinition-us-core-encounter.html\">US Core Encounter Profile</a></p></div><p><b>status</b>: finished</p><p><b>class</b>: Ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'Ambulatory')</p><p><b>type</b>: Consultation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT[US]</a>#11429006)</span></p><p><b>subject</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p></div>"
},
"status" : "finished",
"class" : {
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "AMB",
"display" : "Ambulatory"
},
"type" : [
{
"coding" : [
{
"system" : "http://snomed.info/sct",
"version" : "http://snomed.info/sct/731000124108",
"code" : "11429006",
"display" : "Consultation"
}
]
}
],
"subject" : {
"reference" : "Patient/1"
}
},
"response" : {
"status" : "200"
}
},
{
"fullUrl" : "https://example.com/base/Encounter/7-1",
"resource" : {
"resourceType" : "Encounter",
"id" : "7-1",
"meta" : {
"lastUpdated" : "2019-10-15T20:26:23.217+00:00",
"profile" : [
"http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"7-1\" Updated \"2019-10-15 08:26:23+0000\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/core/STU3.1/StructureDefinition-us-core-encounter.html\">US Core Encounter Profile</a></p></div><p><b>status</b>: finished</p><p><b>class</b>: Ambulatory (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code AMB = 'ambulatory', stated as 'Ambulatory')</p><p><b>type</b>: Consultation <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"https://browser.ihtsdotools.org/\">SNOMED CT[US]</a>#11429006)</span></p><p><b>subject</b>: <a href=\"#Patient_1\">See above (Patient/1)</a></p></div>"
},
"status" : "finished",
"class" : {
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "AMB",
"display" : "Ambulatory"
},
"type" : [
{
"coding" : [
{
"system" : "http://snomed.info/sct",
"version" : "http://snomed.info/sct/731000124108",
"code" : "11429006",
"display" : "Consultation"
}
]
}
],
"subject" : {
"reference" : "Patient/1"
}
},
"response" : {
"status" : "200"
}
},
{
"fullUrl" : "https://example.com/base/Provenance/1000002-1",
"resource" : {
"resourceType" : "Provenance",
"id" : "1000002-1",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2019-07-14T19:26:23.217+00:00",
"profile" : [
"http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"1000002-1\" Version \"1\" Updated \"2019-07-14 07:26:23+0000\" </p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-pdex-provenance.html\">Provenance</a></p></div><p><b>target</b>: <a href=\"#Encounter_6-1\">See above (https://example.com/base/Encounter/6-1)</a></p><p><b>recorded</b>: Jul 10, 2020 4:26:23 PM</p><h3>Agents</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Who</b></td></tr><tr><td>*</td><td>Author <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-provenance-participant-type.html\">Provenance participant type</a>#author)</span></td><td><a href=\"Organization-ProviderOrg1.html\">Organization/ProviderOrg1</a> \"Provider 1\"</td></tr></table><h3>Entities</h3><table class=\"grid\"><tr><td>-</td><td><b>Extension</b></td><td><b>Role</b></td><td><b>What</b></td></tr><tr><td>*</td><td></td><td>source</td><td><span>: No reference available</span></td></tr></table></div>"
},
"target" : [
{
"reference" : "https://example.com/base/Encounter/6-1"
}
],
"recorded" : "2020-07-10T16:26:23.217+00:00",
"agent" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
"code" : "author",
"display" : "Author"
}
]
},
"who" : {
"reference" : "Organization/ProviderOrg1"
}
}
],
"entity" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/ProvenanceSourceFrom",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/ProvenancePayerDataSource",
"code" : "hl7ccda",
"display" : "HL7 C-CDA"
}
]
}
}
],
"role" : "source",
"what" : {
"display" : "No reference available"
}
}
]
},
"response" : {
"status" : "200"
}
},
{
"fullUrl" : "https://example.com/base/Provenance/1000003-1",
"resource" : {
"resourceType" : "Provenance",
"id" : "1000003-1",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2019-10-15T20:26:23.217+00:00"
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"1000003-1\" Version \"1\" Updated \"2019-10-15 08:26:23+0000\" </p></div><p><b>target</b>: <a href=\"#Encounter_7-1\">See above (Encounter/7-1)</a></p><p><b>recorded</b>: Jul 10, 2020 4:26:23 PM</p><h3>Agents</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Who</b></td></tr><tr><td>*</td><td>Author <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-provenance-participant-type.html\">Provenance participant type</a>#author)</span></td><td><a href=\"Organization-ProviderOrg1.html\">Organization/ProviderOrg1</a> \"Provider 1\"</td></tr></table><h3>Entities</h3><table class=\"grid\"><tr><td>-</td><td><b>Extension</b></td><td><b>Role</b></td><td><b>What</b></td></tr><tr><td>*</td><td></td><td>source</td><td><span>: No reference available</span></td></tr></table></div>"
},
"target" : [
{
"reference" : "Encounter/7-1"
}
],
"recorded" : "2020-07-10T16:26:23.217+00:00",
"agent" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
"code" : "author",
"display" : "Author"
}
]
},
"who" : {
"reference" : "Organization/ProviderOrg1"
}
}
],
"entity" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/ProvenanceSourceFrom",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/davinci-pdex/CodeSystem/ProvenancePayerDataSource",
"code" : "hl7ccda",
"display" : "HL7 C-CDA"
}
]
}
}
],
"role" : "source",
"what" : {
"display" : "No reference available"
}
}
]
},
"response" : {
"status" : "200"
}
},
{
"fullUrl" : "https://example.com/base/Provenance/1000004-1",
"resource" : {
"resourceType" : "Provenance",
"id" : "1000004-1",
"meta" : {
"versionId" : "1",
"lastUpdated" : "2019-12-31T20:26:23.217+00:00"
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"1000004-1\" Version \"1\" Updated \"2019-12-31 08:26:23+0000\" </p></div><p><b>target</b>: <a href=\"Bundle-1000000-1.html\">Bundle/1000000-1</a></p><p><b>recorded</b>: Dec 31, 2019 8:26:23 PM</p><h3>Agents</h3><table class=\"grid\"><tr><td>-</td><td><b>Type</b></td><td><b>Role</b></td><td><b>Who</b></td></tr><tr><td>*</td><td>Transmitter <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://hl7.org/fhir/us/core/STU3.1/CodeSystem-us-core-provenance-participant-type.html\">US Core Provenance Participant Type Extension Codes</a>#transmitter)</span></td><td>Transcriber <span style=\"background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki\"> (<a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-contractsignertypecodes.html\">Contract Signer Type Codes</a>#TRANS)</span></td><td><a href=\"Organization-Payer1.html\">Organization/Payer1</a> \"Payer 1\"</td></tr></table></div>"
},
"target" : [
{
"reference" : "Bundle/1000000-1"
}
],
"recorded" : "2019-12-31T20:26:23.217+00:00",
"agent" : [
{
"type" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/core/CodeSystem/us-core-provenance-participant-type",
"code" : "transmitter",
"display" : "Transmitter"
}
]
},
"role" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/contractsignertypecodes",
"code" : "TRANS"
}
]
}
],
"who" : {
"reference" : "Organization/Payer1"
}
}
]
},
"response" : {
"status" : "200"
}
}
]
}
IG © 2020+ HL7 Financial Management Working Group. Package hl7.fhir.us.davinci-pdex#2.0.0-ballot based on FHIR 4.0.1. Generated 2022-02-18
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