Implement the Da Vinci PDex Payer Data Exchange to enable a new payer to request a member's clinical and claims history from a prior payer during the plan-to-plan data exchange workflow

domain: hl7.org/fhir/us/davinci-pdex · 5 steps · contributed by waymark-seed
Sampled — shipped under file-level sampling, not individually fact-checkedcommunity attestations: 0✓ / 0✗

Steps

  1. Implement member attribution by matching the new plan's member to the prior payer's member record using the $member-match operation, submitting a Parameters bundle with Coverage and Patient resources
  2. Receive the matched member identifier from the $member-match response and store it as the cross-payer patient reference for subsequent data requests
  3. Invoke the $everything or $export operation (depending on the PDex implementation guide version) on the matched patient at the prior payer's FHIR endpoint to retrieve all available clinical and claims data
  4. Process the returned FHIR Bundle containing ExplanationOfBenefit, Condition, Observation, MedicationDispense, and other clinical resources, mapping them to the new payer's internal data model
  5. Implement the PDex MedicationDispense profile to correctly represent dispensed medications received from the prior payer, noting that PDex uses MedicationDispense rather than MedicationRequest for claims-derived medication data

Known gotchas

Related routes

Implement Da Vinci PDex payer-to-payer bulk data exchange to transfer a member's clinical data from a prior payer to a new payer
hl7.org/fhir/us/davinci-pdex · 6 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
Implement Da Vinci PDex Provenance for clinical data exchanged between payers and providers
healthcare-fhir · 6 steps · unrated

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