FHIR IG analytics

Resources that use this resource

No resources found

Resources that this resource uses

No resources found

Narrative

Note: links and images are rebased to the (stated) source

Source1

{
  "resourceType": "OperationDefinition",
  "id": "ProviderMemberMatch",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "fm"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "informative",
      "_valueCode": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex"
          }
        ]
      }
    }
  ],
  "url": "http://hl7.org/fhir/us/davinci-pdex/OperationDefinition/ProviderMemberMatch",
  "version": "2.1.1",
  "name": "ProviderMemberMatch",
  "title": "PDex Provider-Member-Match Operation",
  "status": "active",
  "kind": "operation",
  "experimental": true,
  "date": "2024-12-16T00:00:00Z",
  "publisher": "HL7 International / Financial Management",
  "contact": [
    {
      "name": "HL7 International / Financial Management",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/fm"
        },
        {
          "system": "email",
          "value": "fm@lists.HL7.org"
        }
      ]
    },
    {
      "name": "Mark Scrimshire (mark.scrimshire@onyxhealth.io)",
      "telecom": [
        {
          "system": "email",
          "value": "mailto:mark.scrimshire@onyxhealth.io"
        }
      ]
    },
    {
      "name": "HL7 International - Financial Management",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/fm"
        }
      ]
    }
  ],
  "description": "Provider-Member-Match Operation enables providers to match patient demographics and coverage information against a payer's member records. The operation returns matched members as a Group resource that can be used with the $davinci-data-export operation for bulk data retrieval. This operation aligns with the Payer-to-Payer Bulk Member Match but is designed for provider-initiated requests.\n\nThe matched members returned in the MatchedMembers Group can be used directly with the $davinci-data-export operation on the Group resource to retrieve bulk FHIR data for all matched members. The $davinci-data-export operation will return a manifest file referencing the bulk data files containing the member health information in ndjson format.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US",
          "display": "United States of America"
        }
      ]
    }
  ],
  "code": "provider-member-match",
  "comment": "The Group resources returned by this operation can be used as input to the $davinci-data-export operation to perform bulk member matching and retrieve the associated bulk member health history data.",
  "resource": [
    "Group"
  ],
  "system": false,
  "type": true,
  "instance": false,
  "parameter": [
    {
      "name": "MembersToMatch",
      "use": "in",
      "min": 1,
      "max": "*",
      "documentation": "Contains one or more members with patient demographics and coverage information to be matched against the payer's member records.",
      "type": "Parameters",
      "part": [
        {
          "name": "MemberPatient",
          "use": "in",
          "min": 1,
          "max": "1",
          "documentation": "The patient demographics for a member to be matched.",
          "type": "Patient",
          "targetProfile": [
            "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-patient-demographics"
          ]
        },
        {
          "name": "CoverageToMatch",
          "use": "in",
          "min": 1,
          "max": "1",
          "documentation": "The member's existing or previous coverage information to match against.",
          "type": "Coverage",
          "targetProfile": [
            "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"
          ]
        },
        {
          "name": "CoverageToLink",
          "use": "in",
          "min": 0,
          "max": "1",
          "documentation": "Optional: The member's new coverage information to link to (e.g., during plan transitions).",
          "type": "Coverage",
          "targetProfile": [
            "http://hl7.org/fhir/us/davinci-hrex/StructureDefinition/hrex-coverage"
          ]
        },
        {
          "name": "TreatmentAttestation",
          "use": "in",
          "min": 1,
          "max": "1",
          "documentation": "Provider's attestation to an active treatment relationship with the patient. This replaces the general consent with a specific treatment relationship attestation.",
          "type": "Consent",
          "targetProfile": [
            "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/provider-treatment-relationship-consent"
          ]
        }
      ]
    },
    {
      "name": "MatchedMembers",
      "use": "out",
      "min": 0,
      "max": "1",
      "documentation": "A Group resource containing members successfully matched and for whom a treatment relationship has been confirmed. This Group can be used with the $davinci-data-export operation to retrieve bulk data.",
      "type": "Group",
      "targetProfile": [
        "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/member-provider-treatment-relationship-group"
      ]
    },
    {
      "name": "NonMatchedMembers",
      "use": "out",
      "min": 0,
      "max": "1",
      "documentation": "A Group resource containing members for whom no match could be found in the payer's member records, or for whom the provider's treatment attestation could not be verified or does not meet the payer's requirements.",
      "type": "Group",
      "targetProfile": [
        "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-member-no-match-group"
      ]
    },
    {
      "name": "ConsentConstrainedMembers",
      "use": "out",
      "min": 0,
      "max": "1",
      "documentation": "A Group resource containing members who have opted out of data sharing with providers or this specific provider.",
      "type": "Group",
      "targetProfile": [
        "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/member-opt-out-group"
      ]
    }
  ]
}