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 "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><h2>DaVinciPayerDataExchange</h2>The official URL for this implementation guide is: <pre>http://hl7.org/fhir/us/davinci-pdex/ImplementationGuide/hl7.fhir.us.davinci-pdex</pre><div>This specification has undergone ballot and connectathon testing. It is expected to evolve, possibly significantly, as part of that process.\nFeedback 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.\nThis 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.\n<a href=\"https://confluence.hl7.org/display/FM/Financial+Management+Home\">Financial Management</a> is the Sponsoring Work Group for this Implementation Guide.\nThe 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 Profiles based on FHIR R4) which can be understood by providers and, if they choose to, committed to their Electronic Medical Records (EMR) System.\nThe 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.\nThis IG uses the same Member Health History &quot;payload&quot; for member-authorized exchange of information with other Health Plans 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.\nThis IG covers the exchange of:\n<ul>\n<li>Claims-based information</li>\n<li>Clinical Information (such as Lab Results, Allergies and Conditions)</li>\n</ul>\nThis 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.\nThis IG covers the exchange of a Member's Health History in the following scenarios:\n<ul>\n<li>Provider requested Provider-Health Plan Exchange using CDS-Hooks and SMART-on-FHIR</li>\n<li>Member-authorized Health Plan to Health Plan exchange</li>\n<li>Member-authorized Health Plan to Third-Party Application exchange</li>\n</ul>\nThe latter two scenarios are provided to meet the requirements identified in the CMS Interoperability and Patient Access Final Rule.\nThere are items in this guide that are subject to update. This includes:\n<ul>\n<li>Value Sets</li>\n<li>Vocabularies (X12, NUBC etc.)</li>\n<li>Examples</li>\n</ul>\nThe Vocabulary, Value Sets and codings used to express data in this IG are subject to review and will be reconciled with <a href=\"http://www.x12.org\">X12</a>.\nSee the <a href=\"toc.html\">Table of Contents</a> for more information.\n</div></div>"
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 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "ValueSet"
 }
 ],
 "reference": {
 "reference": "ValueSet/NdhAssociatedServersTypeVS"
 },
 "name": "Associated Servers Type Value Set",
 "description": "Associated Servers Type",
 "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": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/CredentialStatusCS"
 },
 "name": "Credential Status Code System",
 "description": "This code system contains codes for indicating the status of a credential, such as an identifier or qualification.",
 "exampleBoolean": false
 },
 {
 "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": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/EndpointAccessControlMechanismCS"
 },
 "name": "Endpoint Access Control Mechanism Code System",
 "description": "Endpoint Access Control Mechanism",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "ValueSet"
 }
 ],
 "reference": {
 "reference": "ValueSet/EndpointAccessControlMechanismVS"
 },
 "name": "Endpoint Access Control Mechanism Value Set",
 "description": "Codes for documenting access control mechanism",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/EndpointConnectionTypeVersionCS"
 },
 "name": "Endpoint Connection Type Version Code System",
 "description": "Endpoint Connection Type Version",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "ValueSet"
 }
 ],
 "reference": {
 "reference": "ValueSet/EndpointConnectionTypeVersionVS"
 },
 "name": "Endpoint Connection Type Version Value Set",
 "description": "Endpoint Connection Type Version",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/EndpointConnectionTypeCS"
 },
 "name": "Endpoint Connection Types (additional) Code System",
 "description": "Extension codes for http://terminology.hl7.org/CodeSystem/endpoint-connection-type",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "ValueSet"
 }
 ],
 "reference": {
 "reference": "ValueSet/EndpointConnectionTypeVS"
 },
 "name": "Endpoint Connection Types Value Set",
 "description": "Endpoint Connection Types",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/EndpointFhirMimeTypeCS"
 },
 "name": "Endpoint FHIR MimeType Code System",
 "description": "Endpoint FHIR MimeType",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "ValueSet"
 }
 ],
 "reference": {
 "reference": "ValueSet/EndpointFhirMimeTypeVS"
 },
 "name": "Endpoint FHIR Mimetype Value Set",
 "description": "Endpoint FHIR mimetype",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/EndpointHieSpecificConnectionTypeCS"
 },
 "name": "Endpoint HIE Specific Connection Type Code System",
 "description": "Endpoint HIE Specific Connection Type",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "ValueSet"
 }
 ],
 "reference": {
 "reference": "ValueSet/EndpointPayloadTypeVS"
 },
 "name": "Endpoint Payload Type Value Set",
 "description": "Endpoint Payload Types are constrained to NA (Not Applicable) as part of this IG",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/EndpointPayloadTypeCS"
 },
 "name": "Endpoint Payload Types Code System",
 "description": "Endpoint Payload Types are constrained to NA (Not Applicable) as part of this IG",
 "exampleBoolean": false
 },
 {
 "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": "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": "ValueSet"
 }
 ],
 "reference": {
 "reference": "ValueSet/IdentifierStatusVS"
 },
 "name": "Identifier Status Value Set",
 "description": "Codes for Identifier Status",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/IdentifierTypeCS"
 },
 "name": "Identifier Type",
 "description": "Identifier Type",
 "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": "ValueSet"
 }
 ],
 "reference": {
 "reference": "ValueSet/BundleTypeVS"
 },
 "name": "mTLS Bundle Type Value Set",
 "description": "Categories of bundle.",
 "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/MtlsObjectType"
 },
 "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": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/NdhAssociatedServersTypeCS"
 },
 "name": "NDH Associated Servers Type Code System",
 "description": "NDH Associated Servers Type",
 "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": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/NdhFhirEndpointUseCaseCS"
 },
 "name": "NDH FHIR Endpoint Use Case Code System",
 "description": "NDH FHIR Endpoint Use Case",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "ValueSet"
 }
 ],
 "reference": {
 "reference": "ValueSet/NdhFhirEndpointUseCaseVS"
 },
 "name": "NDH FHIR Endpoint Usecase Value Set",
 "description": "Codes for documenting business use case by a general grouping by business area.",
 "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": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/NdhVerificationStatusCS"
 },
 "name": "NDH Resource Instance Verification Status Code System",
 "description": "NDH Resource Instance Verification Status",
 "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": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/NdhSecureExchangeArtifactsCS"
 },
 "name": "NDH Secure Exchange Artifacts Code System",
 "description": "NDH 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/NdhVerificationStatusVS"
 },
 "name": "NDH Verification Status Value Set",
 "description": "Codes for verification status",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "CodeSystem"
 }
 ],
 "reference": {
 "reference": "CodeSystem/OrgTypeCS"
 },
 "name": "Organization Type",
 "description": "Categories of organizations based on criteria in provider directories.",
 "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": "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": "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 PDex 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/PDexAdjudicationCS"
 },
 "name": "PDex Adjudication Codes",
 "description": "Describes the various amount fields used when payers receive and adjudicate a claim. It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication.",
 "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": "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": "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": "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/PdexProviderExportModeCS"
 },
 "name": "PDex Provider Export Mode",
 "description": "Data Export Mode Types for Provider Export Operation.",
 "exampleBoolean": false
 },
 {
 "extension": [
 {
 "url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
 "valueString": "ValueSet"
 }
 ],
 "reference": {
 "reference": "ValueSet/PDexProviderExportModeVS"
 },
 "name": "PDex Provider Export Value Set",
 "description": "Provider Request Export Mode",
 "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 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 Servers 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": "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": "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": "Coverage"
 }
 ],
 "reference": {
 "reference": "Coverage/Coverage1"
 },
 "name": "PriorAuthCoverage",
 "description": "Health Plan Coverage for Prior Authorization",
 "exampleBoolean": true
 },
 {
 "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",
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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. 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 }
 ],
 "nameUrl": "artifacts.html",
 "title": "FHIR Artifacts",
 "generation": "html"
 },
 {
 "extension": [
 {
 "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-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"
 }
 ]
 }
}

name : DaVinciPayerDataExchange

{

}