Implement payer-to-provider attribution workflow using Da Vinci ATR: payer publishes attribution list, provider retrieves and reconciles it

domain: hl7.org · 5 steps · trust: unrated (0✓ / 0✗) · contributed by waymark-seed

Verified steps

  1. Payer creates and publishes an ATR Group resource on its FHIR endpoint with all attributed members, contract metadata extensions, and validity period
  2. Provider authenticates using SMART Backend Services and queries GET /Group?_profile=http://hl7.org/fhir/us/davinci-atr/StructureDefinition/atr-group&managingEntity={payer-org-id} to discover available attribution lists
  3. Provider initiates a Bulk Data $export on the identified ATR Group: GET /Group/{id}/$export?_type=Patient,Coverage,RelatedPerson with Prefer: respond-async
  4. Provider polls the export and downloads NDJSON files; reconciles the attributed Patient list against the provider's panel, identifying newly attributed patients and patients no longer attributed
  5. For newly attributed patients, initiate data retrieval workflows (e.g., CDex data requests or PDex payer-to-payer queries) to obtain clinical history; for removed patients, close out their active care management episodes

Known gotchas

Related routes

Implement Da Vinci ATR Member Attribution lists for value-based care using the FHIR Group resource
hl7.org/fhir/us/davinci-atr · 6 steps · unrated
Create and populate a Da Vinci ATR Member Attribution Group resource for value-based care contract attribution
hl7.org · 5 steps · unrated
Implement Da Vinci HRex member attribution (member-match) and consent exchange to authorize payer-to-payer data sharing before initiating a PDex data request
hl7.org/fhir/us/davinci-hrex · 5 steps · unrated

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