Payer Services PDex Patient FHIR Interaction Specification
Service Overview
InterSystems Payer Services PDex APIs support the sharing of patient health data and are designed in compliance with the CMS-0057-F regulationsOpens in a new tab. The APIs allow patients to access the health information held by their payer, providers to access clinical data for patients they have a relationship with, and payers to access health data for their members who have multiple or prior health plans.
The /Patient interactions apply only to provider access use cases for single patient requests.
Refer to the Getting Started section for information on connectivity, authentication and how to get help. To use the REST APIs, you will need to know the server URL of the FHIR server you will be connecting to.
Workflow
A typical provider workflow involving Patient interactions might be:
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The provider uses the $member-match operation to request the unique member FHIR identifier for a patient from the patient’s payer. Alternatively, they may search by member identifier of type “MB”.
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The payer returns the patient identifiers.
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The provider then invokes the $everything operation to retrieve the patient's data from the payer.
/Patient Interactions
Base URL
<server url>/csp/healthshare/<namespace>/app/api/responder/FHIRResponderService
where <server url> and <namespace> have been given to you by the payer organization you are connecting with.
Required Header Settings
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Accept: application/fhir+json or */*
Supported Interactions
Used by a provider to match a single patient to a payer member record. The provider submits the patient’s demographic and coverage information. The operation validates the request, performs the match, and, if a match is found, returns the member ID and MPI ID.
For more information on this interaction, see $member-match.
where <memberID>is the member identifier number, typically their payer card number.
Used by a provider to find a patient using their member identifier (identifier type “MB”). Typically, a FHIR Bundle of type searchset is returned containing the matching Patient resource.
where <MPIID>is the patient identifier number.
Used by a provider to retrieve a patient’s data from their payer using the MPI ID returned from a $member-match request.
For more information on this interaction, see $everything.
Request Body
None.
Success Response
The request succeeded.
Error Responses
The following response error codes are possible when using the /Patient interaction:
Possible causes include:
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Unsupported search parameter
Possible causes include:
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No valid token found
The requester does not have the necessary permissions, accompanied by an OperationOutcomeOpens in a new tab resource that indicates the specific nature of the failure. This could include:
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Token does not include required OAuth scopes
The specified Patient was not found.
Possible causes include:
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Accept header does not include application/fhir+json.
Error from payer's service accompanied by an OperationOutcomeOpens in a new tab resource that indicates the specific nature of the failure. This could include:
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Payer's system has missing configuration information
Possible causes include:
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An internal request in the process timed out