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
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
Receive the matched member identifier from the $member-match response and store it as the cross-payer patient reference for subsequent data requests
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
Process the returned FHIR Bundle containing ExplanationOfBenefit, Condition, Observation, MedicationDispense, and other clinical resources, mapping them to the new payer's internal data model
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
$member-match is a blocking synchronous operation but the data exchange ($everything or $export) is asynchronous; implement separate state machines for the match phase and the data retrieval phase
Prior payers are only required to exchange data for the period of the member's coverage with them; data outside the coverage period may be excluded even if it exists in their systems
PDex uses OAuth2 with SMART Backend Services for system-to-system exchange; the new payer must be registered as a trusted client with the prior payer's authorization server before the workflow can proceed
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp