Exchange payer-to-payer patient data using Da Vinci PDex and resolve member attribution between old and new payers

Steps

1. Initiate the payer-to-payer exchange: the new payer (requestor) must first establish the member's identity at the old payer using a member matching operation — POST to '$member-match' on the old payer's FHIR endpoint with a Parameters resource containing CoverageToMatch and MemberPatient
2. Receive the '$member-match' response with a matched Patient resource and a new Coverage resource representing the old payer's member identifier; use these to authorize the data request
3. Request clinical and claims data from the old payer using FHIR bulk export or individual resource queries scoped to the matched patient; PDex specifies ExplanationOfBenefit, Patient, Coverage, MedicationDispense, Observation, Condition, and Procedure as the primary resource types
4. Map the received data to your internal FHIR model; normalize coding systems (ICD-10, CPT, NDC, RxNorm) and resolve any duplicate or conflicting records against your existing member data
5. Store the exchanged data in your FHIR server and surface it to providers via your Patient Access API within the timelines required by the CMS interoperability rule
6. Maintain an audit log of all PDex exchanges including the requesting entity, date, data types exchanged, and member consent status