| Package | hl7.fhir.us.davinci-pdex |
| Type | ImplementationGuide |
| Id | Id |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/us/davinci-pdex/https://build.fhir.org/ig/HL7/davinci-epdx/index.html |
| Url | http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex |
| Version | 2.1.0 |
| Status | active |
| Date | 2024-12-13T18:03:36+00:00 |
| Name | DaVinciPayerDataExchange |
| Title | Da Vinci Payer Data Exchange |
| Experimental | False |
| Realm | us |
| Authority | hl7 |
| Description | This specification has undergone ballot and connectathon testing. It is expected to continue to evolve, possibly significantly, as part of that process. Feedback is welcome and may be submitted through the FHIR JIRA tracker indicating US Da Vinci PDex as the specification. If balloting on this IG, please submit your comments via the tracker and reference them in your ballot submission implementation guide. This guide can be reviewed offline. Go to the Downloads section. Click on the link to download the full Implementation Guide as a zip file. Expand the zip file and use a web browser to launch the index.html file in the directory created by the zip extract process. External hyperlinks in the guide will not be available unless you have an active internet connection. [Financial Management](https://confluence.hl7.org/display/FM/Financial+Management+Home) is the Sponsoring Work Group for this Implementation Guide. **The Payer Data Exchange (PDex) Implementation Guide (IG) is provided for Payers/Health Plans to enable them to create a Member's Health History using clinical resources (based on US Core 3.1.1 and 6.1.0 Profiles based on FHIR R4) which can be understood by providers and, if they choose to, committed to their Electronic Medical Records (EMR) System.** The PDex work group has made changes to the original version of the IG following the publication of the final CMS Interoperability and Patient Access Rule (CMS-9115_ andin STU2.1 the IG has been expanded to meet the requirements of the CMS Prior Authorization Rule (CMS-0057). This IG uses the same Member Health History "payload" for member-authorized exchange of information with other Health Plans, with Providers and with Third-Party Applications. It describes the interaction patterns that, when followed, allow the various parties involved in managing healthcare and payer data to more easily integrate and exchange data securely and effectively. This IG covers the exchange of: - Claims-based information (without financials) - Clinical Information (such as Lab Results, Allergies and Conditions) - Prior Authorization information This IG covers the exchange of this information using US Core and Da Vinci Health Record Exchange (HRex) Profiles. This superset of clinical profiles forms the Health Plan Member's Health History. This IG covers the exchange of a Member's Health History in the following scenarios: - Provider requested exchange using SMART-on-FHIR Bulk exchange - Health Plan Exchange using SMART-on-FHIR - Member-authorized Health Plan to Health Plan exchange - Member-authorized Health Plan to Third-Party Application exchange The latter two scenarios are provided to meet the requirements identified in the CMS Interoperability and Patient Access Final Rule. **There are items in this guide that are subject to update**. This includes: - Value Sets - Vocabularies (X12, NUBC etc.) - Examples **The Vocabulary, Value Sets and codings used to express data in this IG are subject to review and will be reconciled with** [X12](http://www.x12.org). See the [Table of Contents](toc.html) for more information. |
| Copyright | Used by permission of HL7 International, all rights reserved Creative Commons License |
| CapabilityStatement | |
pdex-payer-access-server  | PDex Payer Access Server CapabilityStatement |
| pdex-provider-access-server | PDex Provider Access Server CapabilityStatement |
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: ImplementationGuide hl7.fhir.us.davinci-pdex
The official URL for this implementation guide is:
http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex
This specification has undergone ballot and connectathon testing. It is expected to continue to evolve, possibly significantly, as part of that process. Feedback is welcome and may be submitted through the FHIR JIRA tracker indicating US Da Vinci PDex as the specification. If balloting on this IG, please submit your comments via the tracker and reference them in your ballot submission implementation guide.
This guide can be reviewed offline. Go to the Downloads section. Click on the link to download the full Implementation Guide as a zip file. Expand the zip file and use a web browser to launch the index.html file in the directory created by the zip extract process. External hyperlinks in the guide will not be available unless you have an active internet connection.
Financial Management is the Sponsoring Work Group for this Implementation Guide.
The Payer Data Exchange (PDex) Implementation Guide (IG) is provided for Payers/Health Plans to enable them to create a Member's Health History using clinical resources (based on US Core 3.1.1 and 6.1.0 Profiles based on FHIR R4) which can be understood by providers and, if they choose to, committed to their Electronic Medical Records (EMR) System.
The PDex work group has made changes to the original version of the IG following the publication of the final CMS Interoperability and Patient Access Rule (CMS-9115_ andin STU2.1 the IG has been expanded to meet the requirements of the CMS Prior Authorization Rule (CMS-0057).
This IG uses the same Member Health History "payload" for member-authorized exchange of information with other Health Plans, with Providers and with Third-Party Applications. It describes the interaction patterns that, when followed, allow the various parties involved in managing healthcare and payer data to more easily integrate and exchange data securely and effectively.
This IG covers the exchange of:
This IG covers the exchange of this information using US Core and Da Vinci Health Record Exchange (HRex) Profiles. This superset of clinical profiles forms the Health Plan Member's Health History.
This IG covers the exchange of a Member's Health History in the following scenarios:
The latter two scenarios are provided to meet the requirements identified in the CMS Interoperability and Patient Access Final Rule.
There are items in this guide that are subject to update. This includes:
The Vocabulary, Value Sets and codings used to express data in this IG are subject to review and will be reconciled with X12.
See the Table of Contents for more information.
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],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueString" : "tabbed-snapshots"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-internal-dependency",
"valueCode" : "hl7.fhir.uv.tools.r4#0.3.0"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "copyrightyear"
},
{
"url" : "value",
"valueString" : "2024+"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "releaselabel"
},
{
"url" : "value",
"valueString" : "STU2 Ballot"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "show-inherited-invariants"
},
{
"url" : "value",
"valueString" : "false"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "path-expansion-params"
},
{
"url" : "value",
"valueString" : "../../input/expansion-params.json"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "apply-jurisdiction"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "apply-publisher"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "generate"
},
{
"url" : "value",
"valueString" : "example-narratives"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "shownav"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "path-history"
},
{
"url" : "value",
"valueString" : "http://hl7.org/fhir/us/davinci-pdex/history.html"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "autoload-resources"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "path-liquid"
},
{
"url" : "value",
"valueString" : "template/liquid"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "path-liquid"
},
{
"url" : "value",
"valueString" : "input/liquid"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "path-qa"
},
{
"url" : "value",
"valueString" : "temp/qa"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "path-temp"
},
{
"url" : "value",
"valueString" : "temp/pages"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "path-output"
},
{
"url" : "value",
"valueString" : "output"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "path-suppressed-warnings"
},
{
"url" : "value",
"valueString" : "input/ignoreWarnings.txt"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "template-html"
},
{
"url" : "value",
"valueString" : "template-page.html"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "template-md"
},
{
"url" : "value",
"valueString" : "template-page-md.html"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "apply-contact"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "apply-context"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "apply-copyright"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "apply-license"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "apply-version"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "apply-wg"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "active-tables"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "fmm-definition"
},
{
"url" : "value",
"valueString" : "http://hl7.org/fhir/versions.html#maturity"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "propagate-status"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "excludelogbinaryformat"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "tabbed-snapshots"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
}
],
"resource" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Parameters"
}
],
"reference" : {
"reference" : "Parameters/payer-multi-member-match-in"
},
"name" : "$multi-member-match payer example request",
"description" : "Example of more than one member being submitted to the PDex Payer-to-Payer Multiple Member Match Operation.",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-parameters-multi-member-match-bundle-in"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Parameters"
}
],
"reference" : {
"reference" : "Parameters/payer-multi-member-match-out"
},
"name" : "$multi-member-match payer example response",
"description" : "Example of group record being returned in response to PDex Payer-to-Payer Multiple Member Match Operation.",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-parameters-multi-member-match-bundle-out"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/Acme"
},
"name" : "Acme",
"description" : "Payer Organization",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/mtls-organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/ProvenanceSourceFrom"
},
"name" : "An attribute to describe the data source a resource was constructed from",
"description" : "Attributes that identify the source record format from which data in the referenced resources was derived",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/PriorAuthorizationUtilization"
},
"name" : "An attribute to express the amount of a service or item that has been utilized",
"description" : "Attribute that expresses the amount of an item or service that has been consumed under the current prior authorization.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/DispenseRefill"
},
"name" : "An attribute to express the refill number of a prescription",
"description" : "Attribute that identifies the refill number of a prescription. e.g., 0, 1, 2, etc.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Bundle"
}
],
"reference" : {
"reference" : "Bundle/3000003"
},
"name" : "BundleConditionWithProvenance",
"description" : "A bundle that returns Conditions with provenance using _revinclude=Provenance:target",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Bundle"
}
],
"reference" : {
"reference" : "Bundle/1000000-1"
},
"name" : "BundleExamplePayer1",
"description" : "The bundle pulled from Payer1 by Payer 2 when a member switches to Payer 2. Patient, 2 Encounters and 2 Provenance records.",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Bundle"
}
],
"reference" : {
"reference" : "Bundle/1000000-2"
},
"name" : "BundleExamplePayer2",
"description" : "The bundle pulled from Payer2 by Payer 3 when a member switches to Payer 3. Patient, 2 Encounters and 2 Provenance records plus new records from Payer 2.",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Bundle"
}
],
"reference" : {
"reference" : "Bundle/1000000-3"
},
"name" : "BundleExamplePayer3",
"description" : "The bundle pulled from Payer3 by Payer 4 when a member switches to Payer 4. Patient, 2 Encounters and 2 Provenance records originating from Payer 1 plus new records from Payer 2 and Payer 3, including supporting Provenance records.",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Bundle"
}
],
"reference" : {
"reference" : "Bundle/3000002"
},
"name" : "BundleWithProvenance",
"description" : "A bundle that returns provenance using _revinclude=Provenance:target",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Endpoint"
}
],
"reference" : {
"reference" : "Endpoint/diamond-mtls-endpoint1"
},
"name" : "diamond-mtls-endpoint1",
"description" : "NDH Endpoint compliant Profile as an example of Payer mTLS Endpoint that is linked from Organization and incorporated in bundle",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/mtls-endpoint"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Endpoint"
}
],
"reference" : {
"reference" : "Endpoint/diamond-mtls-endpoint2"
},
"name" : "diamond-mtls-endpoint2",
"description" : "National Directory Query Endpoint Profile as an example of Payer mTLS Endpoint that is linked from Organization and incorporated in bundle",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/mtls-endpoint"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Bundle"
}
],
"reference" : {
"reference" : "Bundle/example-mtls-endpoint-bundle"
},
"name" : "example-mtls-endpoint-bundle",
"description" : "Example of mTLSbundle for Payer Endpoint for Payer-to-Payer Exchange",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/mtls-bundle"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Group"
}
],
"reference" : {
"reference" : "Group/example-pdex-member-consent-constraint-group"
},
"name" : "example-pdex-member-consent-constraint-group",
"description" : "Example of PDex Member Match Group that returns matches that fail the consent decision flow.",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-no-match-group"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Group"
}
],
"reference" : {
"reference" : "Group/07e72a15407547bf9d03f522aa536a72.1"
},
"name" : "example-pdex-member-match-group",
"description" : "Example of PDex Member Match Group that returns successful matches and creates a Group resource for use with bulk operations.",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-match-group"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Group"
}
],
"reference" : {
"reference" : "Group/example-pdex-member-no-match-group"
},
"name" : "example-pdex-member-no-match-group",
"description" : "Example of PDex Member Match Group that returns unsuccessful matches.",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-no-match-group"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Group"
}
],
"reference" : {
"reference" : "Group/Example-PDex-Provider-Group"
},
"name" : "Example-PDex-Provider-Group",
"description" : "Example of a Payer-generated Member Attribution List for an In-Network/Contracted Provider.",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provider-group"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Bundle"
}
],
"reference" : {
"reference" : "Bundle/2000002"
},
"name" : "ExampleBundle1",
"description" : "A simple bundle to demonstrate a provenance example",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Coverage"
}
],
"reference" : {
"reference" : "Coverage/883210"
},
"name" : "ExampleCoverage",
"description" : "Example of a Coverage for a Member",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Device"
}
],
"reference" : {
"reference" : "Device/543210"
},
"name" : "ExampleDevice",
"description" : "Example of a Device from a Claim",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-device"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Provenance"
}
],
"reference" : {
"reference" : "Provenance/1000016"
},
"name" : "ExampleDocRefProvenance",
"description" : "Example of a PDex Provenance record for a PDF embedded or linked in a DocumentReference resource.",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "DocumentReference"
}
],
"reference" : {
"reference" : "DocumentReference/123456"
},
"name" : "ExampleDocumentReference",
"description" : "Example of a US Core DocumentReference with a linked PDF document. The document could also be embedded.",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Encounter"
}
],
"reference" : {
"reference" : "Encounter/6"
},
"name" : "ExampleEncounter1",
"description" : "Example of an Encounter that has a provenance record received by Payer 1",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Encounter"
}
],
"reference" : {
"reference" : "Encounter/7"
},
"name" : "ExampleEncounter2",
"description" : "Example of an Encounter that has a provenance record received by Payer 1",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Encounter"
}
],
"reference" : {
"reference" : "Encounter/8"
},
"name" : "ExampleEncounter3",
"description" : "Example of an Encounter that has a provenance record received by Payer 2",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Location"
}
],
"reference" : {
"reference" : "Location/5"
},
"name" : "ExampleLocation",
"description" : "Example of a Pharmacy Location Record",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "MedicationDispense"
}
],
"reference" : {
"reference" : "MedicationDispense/1000001"
},
"name" : "ExampleMedicationDispenseClaim",
"description" : "Example of a MedicationDispense from a Claim",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-medicationdispense"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Practitioner"
}
],
"reference" : {
"reference" : "Practitioner/4"
},
"name" : "ExamplePractitioner",
"description" : "Example of a Practitioner Record",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Provenance"
}
],
"reference" : {
"reference" : "Provenance/1000002"
},
"name" : "ExampleProvenanceAuthorEncounter6",
"description" : "Example of an author Provenance record displaying a practitioner's organization as the author",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Provenance"
}
],
"reference" : {
"reference" : "Provenance/1000003"
},
"name" : "ExampleProvenanceAuthorEncounter7",
"description" : "Example of an author Provenance record displaying a practitioner's organization as the author",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Provenance"
}
],
"reference" : {
"reference" : "Provenance/1000017"
},
"name" : "ExampleProvenanceBundleTransmitter",
"description" : "Example of a Transmitter Provenance record for a bundle",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Provenance"
}
],
"reference" : {
"reference" : "Provenance/1000101"
},
"name" : "ExampleProvenanceCustodian",
"description" : "Example of a Custodian Provenance record for the contents of a bundle received from another payer",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Provenance"
}
],
"reference" : {
"reference" : "Provenance/1000006"
},
"name" : "ExampleProvenancePayerModified",
"description" : "Example of provenance based on security group recommendations",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Provenance"
}
],
"reference" : {
"reference" : "Provenance/1000005"
},
"name" : "ExampleProvenancePayerSource",
"description" : "Example of a payer being the source of the data",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Provenance"
}
],
"reference" : {
"reference" : "Provenance/1000004"
},
"name" : "ExampleProvenanceSoloPractitioner",
"description" : "Example of an author Provenance record displaying a sole practitioner as the author",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Provenance"
}
],
"reference" : {
"reference" : "Provenance/1000001"
},
"name" : "ExampleProvenanceTransmitter",
"description" : "Example of a Transmitter Provenance record for a bundle",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provenance"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-identifier"
},
"name" : "ExplanationOfBenefit_Identifier",
"description" : "The business/claim identifier of the Explanation of Benefit",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-patient"
},
"name" : "ExplanationOfBenefit_Patient",
"description" : "The reference to the patient",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-service-date"
},
"name" : "ExplanationOfBenefit_ServiceDate",
"description" : "Date of the service for the EOB. The service-date search parameter simplifies the search, since a client doesn't need to know that. For inpatient and outpatient institutional EOB dates they need to search by billablePeriod.period.start, for a pharmacy EOB by item.servicedDate, and for a professional and non-clinician EOB - by item.servicedPeriod.period.start.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-type"
},
"name" : "ExplanationOfBenefit_Type",
"description" : "The type of the ExplanationOfBenefit",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-use"
},
"name" : "ExplanationOfBenefit_Use",
"description" : "The use of the ExplanationOfBenefit",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/FDANationalDrugCode"
},
"name" : "FDA National Drug Code (NDC)",
"description" : "The Drug Listing Act of 1972 requires registered drug establishments to provide the Food and Drug Administration (FDA) with a current list of all drugs manufactured, prepared, propagated, compounded, or processed by it for commercial distribution. (See Section 510 of the Federal Food, Drug, and Cosmetic Act (Act) (21 U.S.C. § 360)). Drug products are identified and reported using a unique, three-segment number, called the National Drug Code (NDC), which serves as a universal product identifier for drugs. FDA publishes the listed NDC numbers and the information submitted as part of the listing information in the NDC Directory which is updated daily.\n\nThe information submitted as part of the listing process, the NDC number, and the NDC Directory are used in the implementation and enforcement of the Act.\n\nUsers should note:\n\nStarting June 1, 2011, only drugs for which electronic listings (SPL) have been submitted to the FDA are included in the NDC Directory. Drugs for which listing information was last submitted to FDA on paper forms, prior to June 2009, are included on a separate file and will not be updated after June 2012.\n\nInformation regarding the FDA published NDC Directory can be found [here](https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory)\n\nUsers should note a few important items\n\n* The NDC Directory is updated daily.\n* The new NDC Directory contains ONLY information on final marketed drugs submitted to the FDA in SPL electronic listing files by labelers.\n* The NDC Directory does not contain all listed drugs. The new version includes the final marketed drugs which listing information were submitted electronically. It does not include animal drugs, blood products, or human drugs that are not in final marketed form, such as Active Pharmaceutical Ingredients(APIs), drugs for further processing, drugs manufactured exclusively for a private label distributor, or drugs that are marketed solely as part of a kit or combination product or inner layer of a multi-level packaged product not marketed individually. For more information about how certain kits or multi-level packaged drugs are addressed in the new NDC Directory, see the NDC Directory Package File definitions document. For the FDA Online Label Repository page and additional resources go to: [FDA Online Label Repository](https://labels.fda.gov/)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/group-code"
},
"name" : "Group_Code",
"description" : "The code of the Group",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/extension-levelOfServiceCode"
},
"name" : "LevelOfServiceCode",
"description" : "A code specifying the level of service being requested (UM06)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-last-typefilter"
},
"name" : "Member Last Resource Filters",
"description" : "Indicates the filters applied to the resources exported in the last export operation. This string can be taken from the DaVinci Data Export Request _typeFilter Parameter.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-last-types"
},
"name" : "Member Last Resource Types",
"description" : "Indicates the resources exported in the last export operation. This string can be taken from the DaVinci Data Export Request _type Parameter.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-last-transmission"
},
"name" : "Member Last Transmission",
"description" : "Indicates the last date/time that data ware requested and transmitted for a member as part of a data delta access request.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-match-parameters"
},
"name" : "Member-Match Input Patient Parameter",
"description" : "Input Patient Parameter supplied for the individual member match (Patient Demographics).",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-members-opted-out"
},
"name" : "Members Opted-out",
"description" : "Indicates the number of members that have opted out of sharing",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/mtls-endpoint"
},
"name" : "mTLS Endpoint",
"description" : "The mTLS Endpoint is used to assist payers in defining their mTLS endpoints and discovering other Payer's mTLS endpoints",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/mtls-bundle"
},
"name" : "mTLS Endpoint Bundle",
"description" : "A bundle of Endpoint and Organization resources to enable mTLS endpoint discovery and configuration.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/MtlsObjectCodeCS"
},
"name" : "mTLS Object Type Code",
"description" : "Codes for the Signed Object Types",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/mtls-organization"
},
"name" : "mTLS Organization",
"description" : "The mTLS Organization record is used to identify the contact information for a Payer that owns a mTLS Endpoint, or is the managing organization tht administers the Endpoint.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/pdex-mtls-signedobject-extension"
},
"name" : "mTLS Signed Object",
"description" : "mTLS Endpoint Signed Object Extension",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/MtlsObjectTypeVS"
},
"name" : "mTLS Signed Object Types",
"description" : "The Object type",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/DiamondOnyxHealth1"
},
"name" : "mtlsorganization2",
"description" : "Example of mTLS Organization",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/mtls-organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-associatedServers"
},
"name" : "NDH Associated Servers",
"description" : "Associated Servers",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-contactpoint-availabletime"
},
"name" : "NDH Contactpoint Availabletime",
"description" : "An extension representing the days and times a contact point is available",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-dynamicRegistration"
},
"name" : "NDH Dynamic Registration",
"description" : "Dynamic Registration",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-endpointAccessControlMechanism"
},
"name" : "NDH Endpoint Access Control Mechanism",
"description" : "Endpoint Access Control Mechanism",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-endpoint-connection-type-version"
},
"name" : "NDH Endpoint Connection Type Version",
"description" : "An extension for endpoint connection type version",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-endpoint-rank"
},
"name" : "NDH Endpoint Rank",
"description" : "Order established by a Role, Organization… for Endpoints capable of transferring the same content",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-endpoint-usecase"
},
"name" : "NDH Endpoint Usecase",
"description" : "EndpointUseCase is an enumeration of the specific use cases (service descriptions) supported by the endpoint",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-fhir-ig"
},
"name" : "NDH FHIR IG",
"description" : "FHIR IG",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-identifier-status"
},
"name" : "NDH Identifier Status",
"description" : "Describes the status of an identifier",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-secureExchangeArtifacts"
},
"name" : "NDH Secure Exchange Artifacts",
"description" : "Secure Exchange Artifacts",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-trustFramework"
},
"name" : "NDH Trust Framework",
"description" : "Trust Framework",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-verification-status"
},
"name" : "NDH Verification Status",
"description" : "Indicates a resource instance verification status",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/OrgTypeVS"
},
"name" : "Organization Type VS",
"description" : "Categories of organizations based on criteria in provider directories.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/Payer1"
},
"name" : "OrganizationPayer1",
"description" : "Example of the Payer Organization",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/Payer1-1"
},
"name" : "OrganizationPayer1-1",
"description" : "Example of the Payer Organization",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/Payer2"
},
"name" : "OrganizationPayer2",
"description" : "Another Example of the Payer Organization",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/Payer2-2"
},
"name" : "OrganizationPayer2-2",
"description" : "Another Example of the Payer Organization",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/ProviderOrg1"
},
"name" : "OrganizationProvider1",
"description" : "Provider Organization Example 1",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/ProviderOrg2"
},
"name" : "OrganizationProvider2",
"description" : "Provider Organization Example 1",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Patient"
}
],
"reference" : {
"reference" : "Patient/1"
},
"name" : "Patient1",
"description" : "Example of a US Core Patient Record for Payer 1",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Patient"
}
],
"reference" : {
"reference" : "Patient/1-2"
},
"name" : "Patient1-2",
"description" : "Example of a US Core Patient Record for Payer 2",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Patient"
}
],
"reference" : {
"reference" : "Patient/100"
},
"name" : "Patient100",
"description" : "Example of a US Core Patient Record for Payer 2",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Patient"
}
],
"reference" : {
"reference" : "Patient/1001"
},
"name" : "Patient1001",
"description" : "Example of a US Core Patient Record matched by old payer in Bulk Member Match",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Patient"
}
],
"reference" : {
"reference" : "Patient/2002"
},
"name" : "Patient2002",
"description" : "Example of a US Core Patient Record matched by old payer in Bulk Member Match",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/ProvenancePayerSourceFormat"
},
"name" : "Payer source of data",
"description" : "Source Data formats used as the source for FHIR referenced record by the Payer.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/pdex-parameters-multi-member-match-bundle-in"
},
"name" : "PDex $multi-member-match request",
"description" : "A Parameters profile defining the inputs to a $bulk-member-match operation performed by a payer system",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/pdex-parameters-multi-member-match-bundle-out"
},
"name" : "PDex $multi-member-match response",
"description" : "A Parameters profile defining the result of a $bulk-member-match operation performed by a payer system",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/PDexAdjudication"
},
"name" : "PDex Adjudication",
"description" : "Describes the various amount fields used when payers receive and adjudicate a claim. It includes the values\ndefined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the C4BB Adjudication CodeSystem.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/PDexAdjudicationCategoryDiscriminator"
},
"name" : "PDex Adjudication Category Discriminator",
"description" : "Used as the discriminator for adjudication.category and item.adjudication.category for the PDex Prior Authorization.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/PDexAdjudicationDiscriminator"
},
"name" : "PDex Adjudication Discriminator",
"description" : "Used as the discriminator for the data elements in adjudication and item.adjudication",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "OperationDefinition"
}
],
"reference" : {
"reference" : "OperationDefinition/bulk-member-match"
},
"name" : "PDex Bulk Member Match Operation",
"description" : "The **$bulk-member-match** operation that can be invoked by either a payer or an EHR or other system, allows one health plan to retrieve a unique identifier for a group resource containing matched members from another health plan using a member's demographic, coverage information with an accompanying consent record. This identifier can then be used to perform subsequent queries and operations. Health Plans implementing a deterministic match will require a match on member id or subscriber id at a minimum (i.e. A pure demographic match will not be supported by such implementations.).",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/pdex-device"
},
"name" : "PDex Device",
"description" : "The PDex Device profile is provided to enable payers to record information about devices used by a member that may not have a UDI number. \nFHIR-29796 PDex Device uses base resource not US Core Implantable Device Profile. Pdex-Device enables payers to record non-implantable device data. CGP Voted on variance approval: Drew Torres/Eric Haas: 9-0-0",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/PDexIdentifierType"
},
"name" : "PDex Identifier Type",
"description" : "Identifier Type codes that extend those defined in http://terminology.hl7.org/CodeSystem/v2-0203 to define the type of identifier payers and providers assign to claims and patients",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/pdex-medicationdispense"
},
"name" : "PDex MedicationDispense",
"description" : "Prescription Medications dispensed by a pharmacy to a health plan member and paid for in full, or in part, by the health plan",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/pdex-member-match-group"
},
"name" : "PDex Member Match Group",
"description" : "A Group List created by the Payer to enable Bulk Payer-to-Payer API access by Other Payers to retrieve member information. Based on the Group resource. An Extension is added to capture the submitted parameters for the access request.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/pdex-member-no-match-group"
},
"name" : "PDex Member No Match Group",
"description" : "A Group List created by the Payer to provide information back to a requesting payer about failed matches. Based on the Group resource. An Extension is added to capture the submitted patient demographics for the access request. The match may have failed for one of two reasons. a) No match on member. b) Matched but unable to comply with consent request.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/PdexMultiMemberMatchResultCS"
},
"name" : "PDex Multi-Member Match Result Code System",
"description" : "Code set to describe the results group from a multi-member Match operation",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/PDexMultiMemberMatchResultVS"
},
"name" : "PDex Multi-Member Match Result Value Set",
"description" : "Codes to describe the results group from a multi-member Match operation or Member Attribution Process.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/PDexPayerAdjudicationStatus"
},
"name" : "PDex Payer Adjudication Status",
"description" : "Describes the various status fields used when payers adjudicate a claim, such as whether the claim was adjudicated in or out of network, if the provider was contracted or non-contracted for the service",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/PDexPayerBenefitPaymentStatus"
},
"name" : "PDex Payer Benefit Payment Status",
"description" : "Indicates the in network or out of network payment status of the claim.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CapabilityStatement"
}
],
"reference" : {
"reference" : "CapabilityStatement/pdex-payer-access-server"
},
"name" : "PDex Payer-Access Server CapabilityStatement",
"description" : "This Section describes the expected capabilities of the PDex Payer-to-Payer API Server actor which supports US Core 3.1.1 or US Core 6.1.0 and is responsible for providing responses to the queries submitted by PDex Payer-to-Payer Requestors. The complete list of FHIR profiles, RESTful operations, and search parameters supported by PDex Payer Access Server for US Core 3.1.1 and US Core 6.1.0 are defined. PDex Payer Access Clients have the option of choosing from this list to access necessary data based on their local use cases and other contextual requirements.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/pdex-priorauthorization"
},
"name" : "PDex Prior Authorization",
"description" : "The PDex Prior Authorization (PPA) profile is based on the ExplanationOfBenefit resource and is provided to enable payers to express Prior Authorization information to members.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/pdex-provenance"
},
"name" : "PDex Provenance",
"description" : "Provenance is provided by the payer to identify the source of the information, whether the data came via a clinical record or a claim record and whether the data was subject to manual transcription or other interpretive transformation. This profile adds PayerSourceFormat as an extension on the entity base element.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/PdexMemberAttributionCS"
},
"name" : "PDex Provider Access API Attribution Code System",
"description" : "Code set to identify group resources from a Member Attribution Process that is used by Provider Access API.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Consent"
}
],
"reference" : {
"reference" : "Consent/no-consent-1"
},
"name" : "PDex Provider Access Consent Example",
"description" : "An example of a PDex Provider Access Consent where a member expresses their desire to opt-out of sharing their data via the Provider Access API.",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provider-consent"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/pdex-provider-consent"
},
"name" : "PDex Provider Access Consent Profile",
"description" : "The PDex Provider Access Consent Profile enables a member to express their preference for the sharing of their healthcare information to providers through the Provider Access API. A member has to actively choose to opt-out of sharing their data.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/pdex-provider-group"
},
"name" : "PDex Provider Group",
"description" : "The Provider Attribution Group List. Based on the Da Vinci Attribution Group (ATRGroup) Profile with the addition of extensions to track latest download for a member. Each member element in the Group record, that is processed by the export operation, should be updated with the execution date/time in lastTransmitted, list of resources (resourceTypes) in lastResources and query filters (filterQueries) in lastFilters.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CapabilityStatement"
}
],
"reference" : {
"reference" : "CapabilityStatement/pdex-provider-access-server"
},
"name" : "PDex provider-access Server CapabilityStatement",
"description" : "This Section describes the expected capabilities of the PDex Payer-to-Payer API Server actor which supports US Core 3.1.1 or US Core 6.1.0 and is responsible for providing responses to the queries submitted by PDex Payer-to-Payer Requestors. The complete list of FHIR profiles, RESTful operations, and search parameters supported by PDex Provider Access Server for US Core 3.1.1 and US Core 6.1.0 are defined. PDex Provider Access Clients have the option of choosing from this list to access necessary data based on their local use cases and other contextual requirements.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CapabilityStatement"
}
],
"reference" : {
"reference" : "CapabilityStatement/pdex-server"
},
"name" : "PDEX Server CapabilityStatement",
"description" : "This Section describes the expected capabilities of the PDex Server actor which supports US Core 3.1.1 and is responsible for providing responses to the queries submitted by PDex Requestors. The complete list of FHIR profiles, RESTful operations, and search parameters supported by PDex Servers for US Core 3.1.1 are defined. PDex Clients have the option of choosing from this list to access necessary data based on their local use cases and other contextual requirements.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CapabilityStatement"
}
],
"reference" : {
"reference" : "CapabilityStatement/pdex-server-6-1"
},
"name" : "PDex Server CapabilityStatement with US core 6.1 support",
"description" : "This Section describes the expected capabilities of the PDex with US Core 6.1 Support Server actor which is responsible for providing responses to the queries submitted by the PDex Requestors. The complete list of FHIR profiles, RESTful operations, and search parameters supported by PDex and US Core Servers are defined. Systems implementing this capability statement should meet the ONC 2015 Common Clinical Data Set (CCDS) access requirement for Patient Selection 170.315(g)(7) and Application Access - Data Category Request 170.315(g)(8) and the ONC [U.S. Core Data for Interoperability (USCDI) Version 3 July 2022](https://www.healthit.gov/isa/sites/isa/files/2022-07/USCDI-Version-3-July-2022-Final.pdf). PDex Clients have the option of choosing from this list to access necessary data based on their local use cases and other contextual requirements.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/PDexSupportingInfoType"
},
"name" : "PDex Supporting Info Type",
"description" : "Claim Information Category - Used as the discriminator for supportingInfo",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/PDexSupportingInfoType"
},
"name" : "PDex SupportingInfo Type",
"description" : "Used as the discriminator for the types of supporting information for the PDEX Prior Authorization.\nBased on the CARIN IG for Blue Button� Implementation Guide.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Coverage"
}
],
"reference" : {
"reference" : "Coverage/Coverage1"
},
"name" : "PDexCoverageExample",
"description" : "Health Plan Coverage for Prior Authorization",
"exampleBoolean" : true
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/pdex-medicationdispense-patient"
},
"name" : "PdexMedicationDispensePatient",
"description" : "Returns dispensed prescriptions for a specific patient.\nNOTE: This Pdex SearchParameter definition extends the usage context of\n[capabilitystatement-expectation](http://hl7.org/fhir/R4/extension-capabilitystatement-expectation.html)\n extension to formally express implementer conformance expectations for these elements:\n - multipleAnd\n - multipleOr\n - comparator\n - modifier\n - chain.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/pdex-medicationdispense-status"
},
"name" : "PdexMedicationDispenseStatus",
"description" : "Status of the prescription dispense.\nNOTE: This SearchParameter definition extends the usage context of\n[capabilitystatement-expectation](http://hl7.org/fhir/R4/extension-capabilitystatement-expectation.html)\n extension to formally express implementer conformance expectations for these elements:\n - multipleAnd\n - multipleOr\n - comparator\n - modifier\n - chain.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/PDexPriorAuth1"
},
"name" : "PdexPriorAuth",
"description" : "PDex Prior Authorization based on EOB Inpatient Example",
"exampleCanonical" : "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-priorauthorization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/PDexPAInstitutionalProcedureCodesVS"
},
"name" : "Prior Authorization Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS",
"description" : "The Value Set is a combination of three Code Systems: CPT (HCPCS I), HCPCS II procedure codes, and HIPPS rate codes. They are submitted by providers to payers to convey the specific procedure performed. Procedure Codes leverage US Core Procedure Codes composition.\n\nThe target set for this value set are the procedure codes from the CPT and HCPCS files and the rate codes from the HIPPS files.\n\nThe Current Procedural Terminology (CPT) code set, created and maintained by the American Medical Association, is the language of medicine today and the code to its future. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT coding is also used for administrative management purposes such as claims processing and developing guidelines for medical care review. Each year, via a rigorous, evidence-based and transparent process, the independent CPT Editorial Panel revises, creates or deletes hundreds of codes in order to reflect current medical practice.\n\nDesignated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services.\n\nAll CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm.\n\nThere are various types of CPT codes:\n\n**Category I:** These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy.\n\n**Category II:** These alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding.\n\n**Category III:** These are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code.\n\n**Proprietary Laboratory Analyses (PLA) codes:** Recently added to the CPT code set, these codes describe proprietary clinical laboratory analyses and can be either provided by a single (solesource) laboratory or licensed or marketed to multiple providing laboratories that are cleared or approved by the Food and Drug Administration (FDA)). This category includes but is not limited to Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA).\n\nTo obtain CPT, please see the license request form [here](http://info.commerce.ama-assn.org/ama-data-file-request-2020)\n\nThe Level II HCPCS codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4 (CPT-4) codes; Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing. Level II alphanumeric procedure and modifier codes comprise the A to V range.\n\nGeneral information can be found here: [https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo](https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo)\n\nReleases can be found here: [https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets](https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets)\n\nThese files contain the Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage and pricing data.\n\nThe Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets\nof patient characteristics (or case-mix groups) health insurers use to make payment\ndeterminations under several prospective payment systems. Case-mix groups are\ndeveloped based on research into utilization patterns among various provider types. For\nthe payment systems that use HIPPS codes, clinical assessment data is the basic input. A\nstandard patient assessment instrument is interpreted by case-mix grouping software\nalgorithms, which assign the case mix group. For payment purposes, at least one HIPPS\ncode is defined to represent each case-mix group. These HIPPS codes are reported on\nclaims to insurers.\nInstitutional providers use HIPPS codes on claims in association with special revenue\ncodes. One revenue code is defined for each prospective payment system that requires\nHIPPS codes. HIPPS codes are placed in data element SV202 on the electronic 837\ninstitutional claims transaction, using an HP qualifier, or in Form Locator (FL) 44\n(\\\"HCPCS/rate\\\") on a paper UB-04 claims form. The associated revenue code is placed in\ndata element SV201 or in FL 42. In certain circumstances, multiple HIPPS codes may\nappear on separate lines of a single claim.\n\nHIPPS codes are alpha-numeric codes of five digits. Each code contains intelligence,\nwith certain positions of the code indicating the case mix group itself, and other positions\nproviding additional information. The additional information varies among HIPPS codes\npertaining to different payment systems, but often provides information about the clinical\nassessment used to arrive at the code. Which positions of the code carry the case mix\ngroup information may also vary by payment systems.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/PriorAuthServiceTypeCodes"
},
"name" : "Prior Authorization Service Type Codes (X12)",
"description" : "Indicates the Type of Service that a Prior Authorization is covering",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/PriorAuthorizationAmounts"
},
"name" : "Prior Authorization value categories",
"description" : "Codes to define Prior Authorization requested, agreed and utilized amounts.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/PriorAuthorizationValueCodes"
},
"name" : "Prior Authorization Values",
"description" : "Codes used to define Prior Authorization categories",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/PDexPAInstitutionalProcedureCodes"
},
"name" : "Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS",
"description" : "The Value Set is a combination of three Code Systems: CPT (HCPCS I), HCPCS II procedure codes, and HIPPS rate codes. They are submitted by providers to payers to convey the specific procedure performed. Procedure Codes leverage US Core Procedure Codes composition.\n\nThe target set for this value set are the procedure codes from the CPT and HCPCS files and the rate codes from the HIPPS files.\n\nThe Current Procedural Terminology (CPT) code set, created and maintained by the American Medical Association, is the language of medicine today and the code to its future. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT coding is also used for administrative management purposes such as claims processing and developing guidelines for medical care review. Each year, via a rigorous, evidence-based and transparent process, the independent CPT Editorial Panel revises, creates or deletes hundreds of codes in order to reflect current medical practice.\n\nDesignated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services.\n\nAll CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm.\n\nThere are various types of CPT codes:\n\n**Category I:** These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy.\n\n**Category II:** These alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding.\n\n**Category III:** These are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code.\n\n**Proprietary Laboratory Analyses (PLA) codes:** Recently added to the CPT code set, these codes describe proprietary clinical laboratory analyses and can be either provided by a single (solesource) laboratory or licensed or marketed to multiple providing laboratories that are cleared or approved by the Food and Drug Administration (FDA)). This category includes but is not limited to Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA).\n\nTo obtain CPT, please see the license request form [here](http://info.commerce.ama-assn.org/ama-data-file-request-2020)\n\nThe Level II HCPCS codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4 (CPT-4) codes; Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing. Level II alphanumeric procedure and modifier codes comprise the A to V range.\n\nGeneral information can be found here: [https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo](https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo)\n\nReleases can be found here: [https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets](https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets)\n\nThese files contain the Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage and pricing data.\n\nThe Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets\nof patient characteristics (or case-mix groups) health insurers use to make payment\ndeterminations under several prospective payment systems. Case-mix groups are\ndeveloped based on research into utilization patterns among various provider types. For\nthe payment systems that use HIPPS codes, clinical assessment data is the basic input. A\nstandard patient assessment instrument is interpreted by case-mix grouping software\nalgorithms, which assign the case mix group. For payment purposes, at least one HIPPS\ncode is defined to represent each case-mix group. These HIPPS codes are reported on\nclaims to insurers.\nInstitutional providers use HIPPS codes on claims in association with special revenue\ncodes. One revenue code is defined for each prospective payment system that requires\nHIPPS codes. HIPPS codes are placed in data element SV202 on the electronic 837\ninstitutional claims transaction, using an HP qualifier, or in Form Locator (FL) 44\n(\\\"HCPCS/rate\\\") on a paper UB-04 claims form. The associated revenue code is placed in\ndata element SV201 or in FL 42. In certain circumstances, multiple HIPPS codes may\nappear on separate lines of a single claim.\n\nHIPPS codes are alpha-numeric codes of five digits. Each code contains intelligence,\nwith certain positions of the code indicating the case mix group itself, and other positions\nproviding additional information. The additional information varies among HIPPS codes\npertaining to different payment systems, but often provides information about the clinical\nassessment used to arrive at the code. Which positions of the code carry the case mix\ngroup information may also vary by payment systems.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/ProvenanceAgentType"
},
"name" : "Provenance Agent Type",
"description" : "Agent role performed relating to referenced resource",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/ProvenancePayerDataSource"
},
"name" : "Provenance Payer Data Source Format",
"description" : "CodeSystem for source formats that identify what non-FHIR source was used to create FHIR record(s)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/ProvenanceAgentRoleType"
},
"name" : "Provenance Roles",
"description" : "CodeSystem for types of role relating to the creation or communication of referenced resources",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/extension-reviewAction"
},
"name" : "ReviewAction",
"description" : "The details of the review action that is necessary for the authorization.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/extension-reviewActionCode"
},
"name" : "ReviewActionCode",
"description" : "The code describing the result of the review.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:extension"
}
],
"reference" : {
"reference" : "StructureDefinition/base-ext-when-adjudicated"
},
"name" : "When Adjudicated",
"description" : "Date and Time when Adjudication Action took place. NOTE: that this extension may be replaced by an inter-version extension after R6 version of the EOB implements this DataTime element.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/X12278ReviewDecisionReasonCode"
},
"name" : "X12 278 Review Decision Reason Codes",
"description" : "Codes used to identify the reason for the health care service review outcome.",
"exampleBoolean" : false
},
{
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"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "changehistory.html"
}
],
"nameUrl" : "changehistory.html",
"title" : "Change History",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "credits.html"
}
],
"nameUrl" : "credits.html",
"title" : "Credits",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "PDexDownloads.html"
}
],
"nameUrl" : "PDexDownloads.html",
"title" : "Downloads",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "artifacts.html"
}
],
"nameUrl" : "artifacts.html",
"title" : "FHIR Artifacts",
"generation" : "html"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "other-igs.html"
}
],
"nameUrl" : "other-igs.html",
"title" : "Other IG Artifacts",
"generation" : "markdown"
}
]
},
"parameter" : [
{
"code" : "path-pages",
"value" : "input/pagecontent"
},
{
"code" : "path-pages",
"value" : "input/intro-notes"
},
{
"code" : "path-resource",
"value" : "input/capabilities"
},
{
"code" : "path-resource",
"value" : "input/examples"
},
{
"code" : "path-resource",
"value" : "input/extensions"
},
{
"code" : "path-resource",
"value" : "input/models"
},
{
"code" : "path-resource",
"value" : "input/operations"
},
{
"code" : "path-resource",
"value" : "input/profiles"
},
{
"code" : "path-resource",
"value" : "input/resources"
},
{
"code" : "path-resource",
"value" : "input/vocabulary"
},
{
"code" : "path-resource",
"value" : "input/maps"
},
{
"code" : "path-resource",
"value" : "input/testing"
},
{
"code" : "path-resource",
"value" : "input/history"
},
{
"code" : "path-resource",
"value" : "fsh-generated/resources"
},
{
"code" : "path-pages",
"value" : "template/config"
},
{
"code" : "path-pages",
"value" : "input/images"
},
{
"code" : "path-tx-cache",
"value" : "input-cache/txcache"
}
]
}
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.