Exchange a prior coverage decision bundle between payers using the Da Vinci PCDE (Payer Coverage Decision Exchange) IG

In-depth guide

Steps

1. Review the PCDE Coverage Transition document structure: a FHIR Document Bundle containing a Composition that sections activeTreatment (CarePlan, prior Coverage, supporting Observations/DiagnosticReports) and otherInformation
2. Confirm the source payer's FHIR server supports the PCDE Composition profile (profile-composition) and that the document can be assembled as a Bundle of type 'document'
3. Use the Da Vinci HRex Task-based exchange mechanism: the receiving payer POSTs a Task resource to the source payer requesting the Coverage Transition document, referencing the member via a Coverage or Patient identifier
4. Monitor Task.status polling until it reaches 'completed'; retrieve the document Bundle from Task.output.valueReference
5. Validate the received Bundle against the PCDE Bundle profile and check that mandatory sections are present before ingesting into the new payer's system
6. Optionally use the PDex $member-match operation beforehand to confirm member identity across payer systems before initiating the PCDE Task request