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PDex (Payer Data Exchange) FHIR API Specification

Service Overview

InterSystems Payer Services PDex (Payer Data Exchange) APIs are designed in compliance with the CMS-0057-F regulationsOpens in a new tab, which were written to improve the exchange of health care data. For Payer-to-Payer Data Exchange, the PDex APIs allow a member's health data to follow them when they move between health plans so that a new payer has a complete clinical and claims history. For Provider Access, the PDex service gives treating providers access to a patient's health data held by the payer to ensure the provider has a more complete view of the patient's history.

Refer to the Getting Started section for information on connectivity, authentication and how to get help.

To use these REST APIs, you will also need to know the base URL of the payer server that you will be connecting to. You can also retrieve the capability statement for the service.

Discovery APIs

The following unauthenticated APIs are available for determining the capabilities and configuration of the PDex service:

Service discovery

  • .well-known/smart-configuration: retrieves the standard JSON discovery file used by SMART on FHIR Backend Services.

  • metadata: retrieves the FHIR CapabilityStatement for the service.

Payer-to-Payer APIs

The following APIs are available to payers for matching the identity of one or more members and retrieving their health data:

Member matching

  • $bulk-member-match: performs matching for one or more members and returns Group information.

Bulk data retrieval

  • /Group: retrieves information about a specific Group, including its members.

  • $davinci-data-export: initiates a bulk data export for the members of a Group.

For a single member request, create a bulk request containing only that member.

Provider Access APIs

The following APIs are available to providers for matching the identity of one or more patients and retrieving their health data:

Patient matching

  • /Patient: searches for a single patient by identifier.

  • $member-match: matches a single patient and returns the matched patient information.

  • $provider-member-match: performs matching for multiple patients and returns Group information.

Individual data retrieval
Bulk data retrieval

  • /Group: retrieves information about a specific Group, including its members.

  • $davinci-data-export: initiates a bulk data export for the members of a Group.

Patient Access APIs

The following Access API is available to patients through their payer's member portal for retrieving their own health data:

Data retrieval

Implementation Guides

The PDex service APIs conform to the specified versions of the following FHIR and Da Vinci Implementation Guides:

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