Type operation provider-member-match

Must be executed asynchronously

Provider-Member-Match Operation enables providers to match patient demographics and coverage information against a payer's member records.
This operation aligns with the Payer-to-Payer Bulk Member Match but is designed for provider-initiated requests.

Applies to: Group

Requires the operation URL (http://hl7.org/fhir/us/davinci-pdex/OperationDefinition/ProviderMemberMatch) as a scope, or a SMART scope granting read and write access to the resource type the operation is executed against.

In parameters

Name Cardinality Type Documentation
MemberBundle 1..*

One or more members with patient demographics and coverage information to be matched against the payer's member records.
MemberPatient 1..1 Patient

Member demographic information as an HRex Patient resource
CoverageToMatch 0..1 Coverage

Current member coverage (member id, subscriber id), typically from their health plan coverage card.
Must be a valid HRex Coverage resource.
CoverageToLink 0..1 Coverage

Optional coverage to link (typically not used).
Must be a valid HRex Coverage resource.
Consent 1..1 Consent

Provider attestation to treatment relationship.
Must be a valid Provider Attestation to Treatment Relationship Consent resource.

Out parameters

Name Cardinality Type Documentation
ConsentConstrainedMembers 0..1 Group

A PDex member no match Group resource resource containing members who have opted out of data sharing with providers or this specific provider.
This Group is not persisted, it is present only in the operation result.
MatchedMembers 1..1 Group

A PDex member match 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.
NonMatchedMembers 0..1 Group

A PDex member no match 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.
This Group is not persisted, it is present only in the operation result.