davinci_pdex_test_kit 0.12.1 → 0.12.2
This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
- checksums.yaml +4 -4
- data/lib/davinci_pdex_test_kit/pdex_payer_client/visual_inspection_and_attestation/authentication.rb +34 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_client/visual_inspection_and_attestation/must_support.rb +40 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_client/visual_inspection_and_attestation/provenance.rb +32 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_client/visual_inspection_and_attestation/receive_must_support.rb +34 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_client/visual_inspection_and_attestation.rb +24 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_client_suite.rb +17 -3
- data/lib/davinci_pdex_test_kit/pdex_payer_server/urls.rb +27 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/bulk_data_transmission_restrictions.rb +33 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/consent_failure.rb +40 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/consent_requirements.rb +40 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/hrex_must_support.rb +35 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/licensing.rb +37 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/member_auth.rb +81 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/mtls.rb +61 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/payer_consent_compliance.rb +33 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/prior_authorization_decisions.rb +35 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/provenance_records.rb +40 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/read_and_search_hrex.rb +35 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation/resources_in_capability_statement.rb +35 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server/visual_inspection_and_attestation.rb +39 -0
- data/lib/davinci_pdex_test_kit/pdex_payer_server_suite.rb +26 -0
- data/lib/davinci_pdex_test_kit/pdex_provider_client_suite.rb +8 -0
- data/lib/davinci_pdex_test_kit/requirements/{generated/davinci-pdex-test-kit_requirements_coverage.csv → davinci_pdex_test_kit_requirements.csv} +108 -59
- data/lib/davinci_pdex_test_kit/requirements/generated/pdex_payer_client_requirements_coverage.csv +29 -0
- data/lib/davinci_pdex_test_kit/requirements/generated/pdex_payer_server_requirements_coverage.csv +479 -0
- data/lib/davinci_pdex_test_kit/requirements/hl7.fhir.us.davinci-pdex_2.0.0_reqs.xlsx +0 -0
- data/lib/davinci_pdex_test_kit/version.rb +2 -2
- data/lib/davinci_pdex_test_kit.rb +0 -1
- metadata +35 -20
- data/lib/davinci_pdex_test_kit/requirements/davinci-pdex-test-kit_out_of_scope_requirements.csv +0 -1
- data/lib/davinci_pdex_test_kit/requirements/davinci-pdex-test-kit_requirements.csv +0 -66
- data/lib/inferno_requirements_tools/ext/inferno_core/runnable.rb +0 -22
- data/lib/inferno_requirements_tools/rake/rakefile_template +0 -19
- data/lib/inferno_requirements_tools/tasks/collect_requirements.rb +0 -228
- data/lib/inferno_requirements_tools/tasks/requirements_coverage.rb +0 -284
- data/lib/requirements_config.yaml +0 -17
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require_relative '../urls'
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module DaVinciPDexTestKit
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class PDexProvenanceTest < Inferno::Test
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include PDexPayerServer::URLs
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title 'Includes and generates provenance records as required'
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description <<~DESCRIPTION
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The Health IT Module
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- Incorporates provenance records received as part of any FHIR data exchange.
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- Generates provenance records for each non-Provenance resource, at a minimum identifying the
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Health Plan as the Transmitter of the data in PDex exchanges.
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DESCRIPTION
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id :pdex_provenance_test
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verifies_requirements 'hl7.fhir.us.davinci-pdex_2.0.0@12',
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'hl7.fhir.us.davinci-pdex_2.0.0@13'
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run do
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identifier = SecureRandom.hex(32)
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wait(
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identifier:,
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message: <<~MESSAGE
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The developer of the Health IT Module attests that the system:
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- Incorporates provenance records received as part of any FHIR data exchange.
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- Generates provenance records for each non-Provenance resource, at a minimum identifying the
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Health Plan as the Transmitter of the data in PDex exchanges.
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[Click here](#{resume_pass_url}?token=#{identifier}) if the system **meets** these requirements.
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[Click here](#{resume_fail_url}?token=#{identifier}) if the system **does not meet** these requirements.
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MESSAGE
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)
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end
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end
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end
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require_relative '../urls'
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module DaVinciPDexTestKit
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class PDexCoverageInteractionSupportTest < Inferno::Test
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include PDexPayerServer::URLs
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title 'Supports Read and Search for the HRex Coverage resource'
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description <<~DESCRIPTION
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The Health IT Module supports the FHIR Read and Search operations for the Coverage resource,
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using the HRex Coverage profile.
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DESCRIPTION
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id :pdex_coverage_interaction_support_test
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verifies_requirements 'hl7.fhir.us.davinci-pdex_2.0.0@17',
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'hl7.fhir.us.davinci-pdex_2.0.0@18'
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run do
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identifier = SecureRandom.hex(32)
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wait(
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identifier:,
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message: <<~MESSAGE
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I attest that the Health IT Module supports both the FHIR Read and Search
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operations for the Coverage resource using the HRex Coverage profile.
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[Click here](#{resume_pass_url}?token=#{identifier}) if the system **meets** these requirements.
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[Click here](#{resume_fail_url}?token=#{identifier}) if the system **does not meet** these requirements.
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MESSAGE
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)
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end
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end
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end
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require_relative '../urls'
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module DaVinciPDexTestKit
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class PDexCapabilityStatementDeclarationTest < Inferno::Test
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include PDexPayerServer::URLs
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title 'Declares resources and operations in CapabilityStatement'
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description <<~DESCRIPTION
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The Health IT Module declares all FHIR resources and operations available via its API
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in its FHIR CapabilityStatement, in accordance with PDex requirements.
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DESCRIPTION
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id :pdex_capability_statement_declaration_test
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verifies_requirements 'hl7.fhir.us.davinci-pdex_2.0.0@15',
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'hl7.fhir.us.davinci-pdex_2.0.0@19'
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run do
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identifier = SecureRandom.hex(32)
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wait(
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identifier:,
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message: <<~MESSAGE
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The developer of the Health IT Module attests that all FHIR resources and operations
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available via a FHIR API endpoint are declared in the system's CapabilityStatement.
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[Click here](#{resume_pass_url}?token=#{identifier}) if the system **meets** these requirements.
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[Click here](#{resume_fail_url}?token=#{identifier}) if the system **does not meet** these requirements.
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MESSAGE
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)
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end
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end
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end
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require_relative 'visual_inspection_and_attestation/bulk_data_transmission_restrictions'
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require_relative 'visual_inspection_and_attestation/consent_requirements'
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require_relative 'visual_inspection_and_attestation/prior_authorization_decisions'
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require_relative 'visual_inspection_and_attestation/payer_consent_compliance'
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require_relative 'visual_inspection_and_attestation/licensing'
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require_relative 'visual_inspection_and_attestation/hrex_must_support'
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require_relative 'visual_inspection_and_attestation/member_auth'
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require_relative 'visual_inspection_and_attestation/provenance_records'
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require_relative 'visual_inspection_and_attestation/read_and_search_hrex'
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require_relative 'visual_inspection_and_attestation/resources_in_capability_statement'
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require_relative 'visual_inspection_and_attestation/mtls'
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require_relative 'visual_inspection_and_attestation/consent_failure'
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module DaVinciPDexTestKit
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class PDexServerVisualInspectionAndAttestationGroup < Inferno::TestGroup
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id :pdex_server_visual_inspection_and_attestation
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title 'Visual Inspection and Attestation'
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description <<~DESCRIPTION
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Perform visual inspections or attestations to ensure that the Server is conformant to the Da Vinci Payer Data Exchange IG requirements.
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DESCRIPTION
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run_as_group
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test from: :pdex_licensing_test
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test from: :pdex_capability_statement_declaration_test
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test from: :pdex_must_support_defined_by_hrex_test
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test from: :pdex_coverage_interaction_support_test
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test from: :pdex_provenance_test
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test from: :pdex_prior_authorization_decisions_test
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test from: :pdex_consent_requirements_test
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test from: :pdex_payer_consent_compliance_test
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test from: :pdex_bulk_data_transmission_restrictions_test
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test from: :pdex_member_authorized_exchange_test
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test from: :pdex_payer_to_payer_mtls
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test from: :pdex_member_match_consent_failure_test
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end
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end
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require_relative 'pdex_payer_server/medication_dispense_group'
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require_relative 'pdex_payer_server/provenance_group'
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require_relative 'pdex_payer_server/urls'
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require_relative 'pdex_payer_server/visual_inspection_and_attestation'
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module DaVinciPDexTestKit
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class PDexPayerServerSuite < Inferno::TestSuite
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id :pdex_payer_server
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}
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]
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requirement_sets(
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{
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identifier: 'hl7.fhir.us.davinci-pdex_2.0.0',
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title: 'Da Vinci Payer Data Exchange (PDex) v2.0.0',
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actor: 'Server'
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},
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{
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identifier: 'hl7.fhir.uv.bulkdata_2.0.0',
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title: 'Bulk Data Access IG',
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actor: 'Server'
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}
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)
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input :url,
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title: 'FHIR Server Base Url'
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end
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end
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resume_test_route :get, PDexPayerServer::RESUME_PASS_PATH do |request|
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request.query_parameters['token']
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end
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resume_test_route :get, PDexPayerServer::RESUME_FAIL_PATH, result: 'fail' do |request|
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request.query_parameters['token']
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end
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group do
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title 'Payer to Payer Workflow'
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id :payer_to_payer_workflow
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end
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end
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end
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group from: :pdex_server_visual_inspection_and_attestation do
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optional
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end
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end
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end
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Req Set,ID,URL,Requirement,Conformance,
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hl7.fhir.us.davinci-pdex_2.0.0,1,https://hl7.org/fhir/us/davinci-pdex/STU2/#intellectual-property,Implementers ... of this specification SHALL abide by the license requirements for each terminology content artifact utilized within a functioning implementation.,SHALL,Server,,false
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hl7.fhir.us.davinci-pdex_2.0.0,2,https://hl7.org/fhir/us/davinci-pdex/STU2/#intellectual-property,Terminology licenses SHALL be obtained from the Third-Party IP owner for each code system and/or other specified artifact used.,SHALL,Server,,false
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hl7.fhir.us.davinci-pdex_2.0.0,3,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"For profiles defined in [US Core and referenced by PDex], the meaning of Must Support [for Servers] is established in [the US Core IG].",SHALL,Server,"hl7.fhir.us.
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hl7.fhir.us.davinci-pdex_2.0.0,4,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"For profiles defined in [US Core and referenced by PDex], the meaning of Must Support [for Clients] is established in [the US Core IG].",SHALL,Client,"hl7.fhir.us.
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hl7.fhir.us.davinci-pdex_2.0.0,5,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"For profiles defined in [DaVinci HRex and referenced by PDex], the meaning of Must Support [for Servers] is established in [the HRex IG].",SHALL,Server,"hl7.fhir.us.davinci-
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hl7.fhir.us.davinci-pdex_2.0.0,6,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"For profiles defined in [DaVinci HRex and referenced by PDex], the meaning of Must Support [for Clients] is established in [the HRex IG].",SHALL,Client,"hl7.fhir.us.davinci-
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hl7.fhir.us.davinci-pdex_2.0.0,7,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"[For profiles defined in the PDex IG, Servers SHALL follow] Must Support requirements … [from] the US Core Implementation Guide.",SHALL,Server,"hl7.fhir.us.
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hl7.fhir.us.davinci-pdex_2.0.0,8,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"[For profiles defined in the PDex IG, Clients SHALL follow] Must Support requirements … [from] the US Core Implementation Guide.",SHALL,Client,"hl7.fhir.us.
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hl7.fhir.us.davinci-pdex_2.0.0,9,https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#overview,All data exchanged by Health Plans using the interactions covered in this IG SHALL be transformed to FHIR R4 resources.,SHALL,Server,,false
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hl7.fhir.us.davinci-pdex_2.0.0,10,"https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#oauth20-or-smart-on-fhir-member-authorized-exchange,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.html,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api",The member SHALL authenticate using
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hl7.fhir.us.davinci-pdex_2.0.0,11,https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#patient-everything-exchange-via-alternate-secure-transport,The use of the Bulk FHIR specification for transmission of member data SHALL honor jurisdictional and personal privacy restrictions that are relevant to a member’s health record.,SHALL,Server,,false
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-
hl7.fhir.us.davinci-pdex_2.0.0,12,https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#provenance,Health Plans SHALL incorporate provenance records that they receive as part of any exchange of FHIR data.,SHALL,Server,,false
|
|
14
|
-
hl7.fhir.us.davinci-pdex_2.0.0,13,https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#provenance,"Health Plans SHALL provide Provenance records [for each non-Provenance instance] that, at a minimum, indicate that they are playing the role of Transmitter of the data in any PDex information exchange.",SHALL,Server,,false
|
|
15
|
-
hl7.fhir.us.davinci-pdex_2.0.0,14,https://hl7.org/fhir/us/davinci-pdex/STU2/introduction.html#implementation-hierarchy-and-priorities,"[F]or profiles and APIs identified in this IG, the FHIR R4 version SHALL be used.",SHALL,Server,,false
|
|
16
|
-
hl7.fhir.us.davinci-pdex_2.0.0,15,https://hl7.org/fhir/us/davinci-pdex/STU2/introduction.html#pdex-data-payloads,All resources available via a FHIR API endpoint SHALL be declared in a FHIR CapabilityStatement.,SHALL,Server,,false
|
|
17
|
-
hl7.fhir.us.davinci-pdex_2.0.0,16,https://hl7.org/fhir/us/davinci-pdex/STU2/introduction.html#pdex-data-payloads,The Read and Search Operations SHALL be supported for the FHIR Profiles [that are part of the member health history].,SHALL,Server,,false
|
|
18
|
-
hl7.fhir.us.davinci-pdex_2.0.0,17,https://hl7.org/fhir/us/davinci-pdex/STU2/introduction.html#capabilitystatement,The Read ... Operation... SHALL be supported for … Resource Type … Coverage [using the [HRex Coverage](https://hl7.org/fhir/us/davinci-hrex/STU1/StructureDefinition-hrex-coverage.html) profile].,SHALL,Server,,false
|
|
19
|
-
hl7.fhir.us.davinci-pdex_2.0.0,18,https://hl7.org/fhir/us/davinci-pdex/STU2/introduction.html#capabilitystatement,The ... Search Operation... SHALL be supported for … Resource Type … Coverage [using the [HRex Coverage](https://hl7.org/fhir/us/davinci-hrex/STU1/StructureDefinition-hrex-coverage.html) profile].,SHALL,Server,,false
|
|
20
|
-
hl7.fhir.us.davinci-pdex_2.0.0,19,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#data-payloads,All resources and operations available via a FHIR API endpoint SHALL be declared in a FHIR CapabilityStatement.,SHALL,Server,,false
|
|
21
|
-
hl7.fhir.us.davinci-pdex_2.0.0,20,"https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#oauth20-or-smart-on-fhir-member-authorized-exchange,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.html,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api","[When a payer allows their member to authorize information sharing, a]fter authenticating to the (source) Health Plan’s authorization server, the Member SHALL be presented with an Authorization screen that enables them to approve the sharing of information with their intended application, service or (target) Health Plan.",SHALL,Server,,false
|
|
22
|
-
hl7.fhir.us.davinci-pdex_2.0.0,21,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,"For this authorization [of data sharing by a member] to occur the Application, service or (target) Health Plan will require OAuth 2.0 client application credentials, which ... the (source) Health Plan [SHALL issue during client] register[ation]",SHALL,Server,,false
|
|
23
|
-
hl7.fhir.us.davinci-pdex_2.0.0,22,"https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.htm","The Authorization process [of data sharing by a member], in accordance with applicable privacy policy, SHALL provide a mechanism to support current regulations allowing members the right to decide what information is permitted to be exchanged.",SHALL,Server,,false
|
|
24
|
-
hl7.fhir.us.davinci-pdex_2.0.0,23,"https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.htm","After successfully authorizing [data sharing with] an application [on behalf of the Member,] an Access Token ... SHALL be returned to the requesting application.",SHALL,Server,,false
|
|
25
|
-
hl7.fhir.us.davinci-pdex_2.0.0,24,"https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.htm","After successfully authorizing [data sharing with] an application [on behalf of the Member,] an … Optional Refresh Token ... [MAY] be returned to the requesting application.",MAY,Server,,false
|
|
26
|
-
hl7.fhir.us.davinci-pdex_2.0.0,25,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,The scopes of the access token [returned by the server for data sharing on behalf of a member] SHALL be restricted to the authorizing Member’s information and the scopes approved.,SHALL,Server,,false
|
|
27
|
-
hl7.fhir.us.davinci-pdex_2.0.0,26,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,Any subsequent Access Token [returned by the server for data sharing on behalf of the member] issued based on the Refresh Token SHALL be restricted (at least) to the same restrictions.,SHALL,Server,,false
|
|
28
|
-
hl7.fhir.us.davinci-pdex_2.0.0,27,"https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.htm",The requesting application [authorized to access member information] SHALL use the access token to access the Health Plan’s secure FHIR API to download the information that the Application is allowed to access.,SHALL,Client,,false
|
|
29
|
-
hl7.fhir.us.davinci-pdex_2.0.0,28,https://hl7.org/fhir/us/davinci-pdex/STU2/handlingdataprovenance.html#handling-data-provenance,Health Plans SHALL accept and retain Provenance records received with data based on Member-authorized Payer-to-Payer exchange.,SHALL,Client,,false
|
|
30
|
-
hl7.fhir.us.davinci-pdex_2.0.0,29,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,Each [data] retrieval ... SHALL be preceded by the use of the ... [HRex [$member-match](https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html)] interaction to match a member and provide consent.,SHALL,Client,"hl7.fhir.us.davinci-
|
|
31
|
-
hl7.fhir.us.davinci-pdex_2.0.0,30,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,Health Plans SHALL support the $member-match operation.,SHALL,Server,"hl7.fhir.us.davinci-
|
|
32
|
-
hl7.fhir.us.davinci-pdex_2.0.0,31,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,"[Before allowing a $member-match operation, Servers SHALL e]stablish a secure connection [with the client payer] via mTLS.",SHALL,Server,,false
|
|
33
|
-
hl7.fhir.us.davinci-pdex_2.0.0,32,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,[Servers SHALL allow clients to u]se mTLS secure connection to perform OAuth2.0 Dynamic Client Registration to acquire OAuth2.0 client credentials,SHALL,Server,,false
|
|
34
|
-
hl7.fhir.us.davinci-pdex_2.0.0,33,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,[Servers SHALL allow clients to u]se Client Credentials to acquire OAuth2.0 token to perform $member-match operation,SHALL,Server,,false
|
|
35
|
-
hl7.fhir.us.davinci-pdex_2.0.0,34,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,"If a Patient ID is returned from $member-match, [Servers SHALL allow clients to make] a request for an OAuth2.0 Access Token that is scoped to the identified shared member",SHALL,Server,,false
|
|
36
|
-
hl7.fhir.us.davinci-pdex_2.0.0,35,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#the-member-match-operation,In the case where a [member] match is confirmed the receiving payer will: … [r]eturn a Unique Patient Identifier (Patient FHIR ID) in the $member-match Operation Response.,SHALL,Server,,true
|
|
37
|
-
hl7.fhir.us.davinci-pdex_2.0.0,36,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#the-member-match-operation,When no [member] match is found ... a 422 Unprocessable entity status code will be returned [by the receiving payer].,SHALL,Server,,true
|
|
38
|
-
hl7.fhir.us.davinci-pdex_2.0.0,37,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#the-member-match-operation,"When … multiple matches are found, a 422 Unprocessable entity status code will be returned [by the receiving payer].",SHALL,Server,,true
|
|
39
|
-
hl7.fhir.us.davinci-pdex_2.0.0,38,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#the-member-match-operation,"If the receiving payer matches to a unique member but is unable to comply with the consent request, a Patient ID SHALL NOT be returned in the $member-match response",SHALL NOT,Server,,true
|
|
40
|
-
hl7.fhir.us.davinci-pdex_2.0.0,39,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#the-member-match-operation,"If the receiving payer matches to a unique member but is unable to comply with the consent request [e.g., because they do not support the requested data segmentation policy], … a 422 status code SHALL be returned with an Operation Outcome that indicates that the consent request could not be complied with.",SHALL,Server,,true
|
|
1
|
+
Req Set,ID,URL,Requirement,Conformance,Actors,Sub-Requirement(s),Conditionality,Not Tested Reason,Not Tested Details
|
|
2
|
+
hl7.fhir.us.davinci-pdex_2.0.0,1,https://hl7.org/fhir/us/davinci-pdex/STU2/#intellectual-property,Implementers ... of this specification SHALL abide by the license requirements for each terminology content artifact utilized within a functioning implementation.,SHALL,Server,,false,,
|
|
3
|
+
hl7.fhir.us.davinci-pdex_2.0.0,2,https://hl7.org/fhir/us/davinci-pdex/STU2/#intellectual-property,Terminology licenses SHALL be obtained from the Third-Party IP owner for each code system and/or other specified artifact used.,SHALL,Server,,false,,
|
|
4
|
+
hl7.fhir.us.davinci-pdex_2.0.0,3,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"For profiles defined in [US Core and referenced by PDex], the meaning of Must Support [for Servers] is established in [the US Core IG [must support section](https://hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support)].",SHALL,Server,"hl7.fhir.us.davinci-pdex_2.0.0@87,89,90,92",false,,
|
|
5
|
+
hl7.fhir.us.davinci-pdex_2.0.0,4,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"For profiles defined in [US Core and referenced by PDex], the meaning of Must Support [for Clients] is established in [the US Core IG [must support section](https://hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support)].",SHALL,Client,"hl7.fhir.us.davinci-pdex_2.0.0@88,91",false,,
|
|
6
|
+
hl7.fhir.us.davinci-pdex_2.0.0,5,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"For profiles defined in [DaVinci HRex and referenced by PDex], the meaning of Must Support [for Servers] is established in [the HRex IG [Conformance section](https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html)].",SHALL,Server,"hl7.fhir.us.davinci-pdex_2.0.0@59,60,62,63,65,67,69,70",false,,
|
|
7
|
+
hl7.fhir.us.davinci-pdex_2.0.0,6,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"For profiles defined in [DaVinci HRex and referenced by PDex], the meaning of Must Support [for Clients] is established in [the HRex IG [Conformance section](https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html)].",SHALL,Client,"hl7.fhir.us.davinci-pdex_2.0.0@61,64,66,68",false,,
|
|
8
|
+
hl7.fhir.us.davinci-pdex_2.0.0,7,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"[For profiles defined in the PDex IG, Servers SHALL follow] Must Support requirements … [from] the US Core Implementation Guide [[must support section](https://hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support)].",SHALL,Server,"hl7.fhir.us.davinci-pdex_2.0.0@87,89,90,92",false,,
|
|
9
|
+
hl7.fhir.us.davinci-pdex_2.0.0,8,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"[For profiles defined in the PDex IG, Clients SHALL follow] Must Support requirements … [from] the US Core Implementation Guide [[must support section](https://hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support)].",SHALL,Client,"hl7.fhir.us.davinci-pdex_2.0.0@88,91",false,,
|
|
10
|
+
hl7.fhir.us.davinci-pdex_2.0.0,9,https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#overview,All data exchanged by Health Plans using the interactions covered in this IG SHALL be transformed to FHIR R4 resources.,SHALL,Server,,false,,
|
|
11
|
+
hl7.fhir.us.davinci-pdex_2.0.0,10,"https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#oauth20-or-smart-on-fhir-member-authorized-exchange,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.html,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api",The member SHALL authenticate using credentials that have been issued by or are recognized and accepted by the Health Plan. These are typically the member’s customer portal credentials for accessing the health plan.,SHALL,Client,,false,,
|
|
12
|
+
hl7.fhir.us.davinci-pdex_2.0.0,11,https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#patient-everything-exchange-via-alternate-secure-transport,The use of the Bulk FHIR specification for transmission of member data SHALL honor jurisdictional and personal privacy restrictions that are relevant to a member’s health record.,SHALL,Server,,false,,
|
|
13
|
+
hl7.fhir.us.davinci-pdex_2.0.0,12,https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#provenance,Health Plans SHALL incorporate provenance records that they receive as part of any exchange of FHIR data.,SHALL,Server,,false,,
|
|
14
|
+
hl7.fhir.us.davinci-pdex_2.0.0,13,https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#provenance,"Health Plans SHALL provide Provenance records [for each non-Provenance instance] that, at a minimum, indicate that they are playing the role of Transmitter of the data in any PDex information exchange.",SHALL,Server,,false,,
|
|
15
|
+
hl7.fhir.us.davinci-pdex_2.0.0,14,https://hl7.org/fhir/us/davinci-pdex/STU2/introduction.html#implementation-hierarchy-and-priorities,"[F]or profiles and APIs identified in this IG, the FHIR R4 version SHALL be used.",SHALL,Server,,false,,
|
|
16
|
+
hl7.fhir.us.davinci-pdex_2.0.0,15,https://hl7.org/fhir/us/davinci-pdex/STU2/introduction.html#pdex-data-payloads,All resources available via a FHIR API endpoint SHALL be declared in a FHIR CapabilityStatement.,SHALL,Server,,false,,
|
|
17
|
+
hl7.fhir.us.davinci-pdex_2.0.0,16,https://hl7.org/fhir/us/davinci-pdex/STU2/introduction.html#pdex-data-payloads,The Read and Search Operations SHALL be supported for the FHIR Profiles [that are part of the member health history].,SHALL,Server,,false,,
|
|
18
|
+
hl7.fhir.us.davinci-pdex_2.0.0,17,https://hl7.org/fhir/us/davinci-pdex/STU2/introduction.html#capabilitystatement,The Read ... Operation... SHALL be supported for … Resource Type … Coverage [using the [HRex Coverage](https://hl7.org/fhir/us/davinci-hrex/STU1/StructureDefinition-hrex-coverage.html) profile].,SHALL,Server,,false,,
|
|
19
|
+
hl7.fhir.us.davinci-pdex_2.0.0,18,https://hl7.org/fhir/us/davinci-pdex/STU2/introduction.html#capabilitystatement,The ... Search Operation... SHALL be supported for … Resource Type … Coverage [using the [HRex Coverage](https://hl7.org/fhir/us/davinci-hrex/STU1/StructureDefinition-hrex-coverage.html) profile].,SHALL,Server,,false,,
|
|
20
|
+
hl7.fhir.us.davinci-pdex_2.0.0,19,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#data-payloads,All resources and operations available via a FHIR API endpoint SHALL be declared in a FHIR CapabilityStatement.,SHALL,Server,,false,,
|
|
21
|
+
hl7.fhir.us.davinci-pdex_2.0.0,20,"https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#oauth20-or-smart-on-fhir-member-authorized-exchange,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.html,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api","[When a payer allows their member to authorize information sharing, a]fter authenticating to the (source) Health Plan’s authorization server, the Member SHALL be presented with an Authorization screen that enables them to approve the sharing of information with their intended application, service or (target) Health Plan.",SHALL,Server,,false,,
|
|
22
|
+
hl7.fhir.us.davinci-pdex_2.0.0,21,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,"For this authorization [of data sharing by a member] to occur the Application, service or (target) Health Plan will require OAuth 2.0 client application credentials, which ... the (source) Health Plan [SHALL issue during client] register[ation]",SHALL,Server,,false,,
|
|
23
|
+
hl7.fhir.us.davinci-pdex_2.0.0,22,"https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.htm","The Authorization process [of data sharing by a member], in accordance with applicable privacy policy, SHALL provide a mechanism to support current regulations allowing members the right to decide what information is permitted to be exchanged.",SHALL,Server,,false,,
|
|
24
|
+
hl7.fhir.us.davinci-pdex_2.0.0,23,"https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.htm","After successfully authorizing [data sharing with] an application [on behalf of the Member,] an Access Token ... SHALL be returned to the requesting application.",SHALL,Server,,false,,
|
|
25
|
+
hl7.fhir.us.davinci-pdex_2.0.0,24,"https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.htm","After successfully authorizing [data sharing with] an application [on behalf of the Member,] an … Optional Refresh Token ... [MAY] be returned to the requesting application.",MAY,Server,,false,,
|
|
26
|
+
hl7.fhir.us.davinci-pdex_2.0.0,25,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,The scopes of the access token [returned by the server for data sharing on behalf of a member] SHALL be restricted to the authorizing Member’s information and the scopes approved.,SHALL,Server,,false,,
|
|
27
|
+
hl7.fhir.us.davinci-pdex_2.0.0,26,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,Any subsequent Access Token [returned by the server for data sharing on behalf of the member] issued based on the Refresh Token SHALL be restricted (at least) to the same restrictions.,SHALL,Server,,false,,
|
|
28
|
+
hl7.fhir.us.davinci-pdex_2.0.0,27,"https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.htm",The requesting application [authorized to access member information] SHALL use the access token to access the Health Plan’s secure FHIR API to download the information that the Application is allowed to access.,SHALL,Client,,false,,
|
|
29
|
+
hl7.fhir.us.davinci-pdex_2.0.0,28,https://hl7.org/fhir/us/davinci-pdex/STU2/handlingdataprovenance.html#handling-data-provenance,Health Plans SHALL accept and retain Provenance records received with data based on Member-authorized Payer-to-Payer exchange.,SHALL,Client,,false,,
|
|
30
|
+
hl7.fhir.us.davinci-pdex_2.0.0,29,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,Each [data] retrieval ... SHALL be preceded by the use of the ... [HRex [$member-match](https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html)] interaction to match a member and provide consent.,SHALL,Client,"hl7.fhir.us.davinci-pdex_2.0.0@72,75,76,78,84,85",false,,
|
|
31
|
+
hl7.fhir.us.davinci-pdex_2.0.0,30,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,Health Plans SHALL support the $member-match operation.,SHALL,Server,"hl7.fhir.us.davinci-pdex_2.0.0@71,73,74,77,79-83,86",false,,
|
|
32
|
+
hl7.fhir.us.davinci-pdex_2.0.0,31,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,"[Before allowing a $member-match operation, Servers SHALL e]stablish a secure connection [with the client payer] via mTLS.",SHALL,Server,,false,,
|
|
33
|
+
hl7.fhir.us.davinci-pdex_2.0.0,32,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,[Servers SHALL allow clients to u]se mTLS secure connection to perform OAuth2.0 Dynamic Client Registration to acquire OAuth2.0 client credentials,SHALL,Server,,false,,
|
|
34
|
+
hl7.fhir.us.davinci-pdex_2.0.0,33,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,[Servers SHALL allow clients to u]se Client Credentials to acquire OAuth2.0 token to perform $member-match operation,SHALL,Server,,false,,
|
|
35
|
+
hl7.fhir.us.davinci-pdex_2.0.0,34,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,"If a Patient ID is returned from $member-match, [Servers SHALL allow clients to make] a request for an OAuth2.0 Access Token that is scoped to the identified shared member",SHALL,Server,,false,,
|
|
36
|
+
hl7.fhir.us.davinci-pdex_2.0.0,35,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#the-member-match-operation,In the case where a [member] match is confirmed the receiving payer will: … [r]eturn a Unique Patient Identifier (Patient FHIR ID) in the $member-match Operation Response.,SHALL,Server,,true,,
|
|
37
|
+
hl7.fhir.us.davinci-pdex_2.0.0,36,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#the-member-match-operation,When no [member] match is found ... a 422 Unprocessable entity status code will be returned [by the receiving payer].,SHALL,Server,,true,,
|
|
38
|
+
hl7.fhir.us.davinci-pdex_2.0.0,37,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#the-member-match-operation,"When … multiple matches are found, a 422 Unprocessable entity status code will be returned [by the receiving payer].",SHALL,Server,,true,,
|
|
39
|
+
hl7.fhir.us.davinci-pdex_2.0.0,38,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#the-member-match-operation,"If the receiving payer matches to a unique member but is unable to comply with the consent request, a Patient ID SHALL NOT be returned in the $member-match response",SHALL NOT,Server,,true,,
|
|
40
|
+
hl7.fhir.us.davinci-pdex_2.0.0,39,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#the-member-match-operation,"If the receiving payer matches to a unique member but is unable to comply with the consent request [e.g., because they do not support the requested data segmentation policy], … a 422 status code SHALL be returned with an Operation Outcome that indicates that the consent request could not be complied with.",SHALL,Server,,true,,
|
|
41
41
|
hl7.fhir.us.davinci-pdex_2.0.0,40,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#evaluation-of-consent,"[Servers SHALL consider consent requirements to be met only if]
|
|
42
42
|
- Member Identity is matched
|
|
43
43
|
- Consent Policy (Everything or only Non-Sensitive data) matches the data release segmentation capabilities of the receiving payer
|
|
44
44
|
- Date period for consent is valid
|
|
45
|
-
- Payer requesting retrieval of data is matched.",SHALL,Server,,false
|
|
45
|
+
- Payer requesting retrieval of data is matched.",SHALL,Server,,false,,
|
|
46
46
|
hl7.fhir.us.davinci-pdex_2.0.0,41,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#data-retrieval-methods,"Once Health Plans have completed the Member Access stage of the Exchange the requesting Health Plan SHALL utilize the access token returned from the Member Access step to request/retrieve data using one of the following three methods:
|
|
47
47
|
- Query all clinical resource individually
|
|
48
48
|
- $patient-everything operation
|
|
49
|
-
- Bulk FHIR Asynchronous protocols.",SHALL,Client,,false
|
|
50
|
-
hl7.fhir.us.davinci-pdex_2.0.0,42,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#data-retrieval-methods,"Each of the above methods[, query all clinical resource individually, $everything, and $export,] SHALL support the retrieval of the profiles and resources [in the scope of the member health history, defined in the Server CapabilityStatement]",SHALL,Server,,false
|
|
51
|
-
hl7.fhir.us.davinci-pdex_2.0.0,43,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#query-all-clinical-resources-individually,Health Plans SHALL support search of a member’s clinical data.,SHALL,Server,,false
|
|
52
|
-
hl7.fhir.us.davinci-pdex_2.0.0,44,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#query-all-clinical-resources-individually,[Servers SHALL support] the _revInclude and _include parameters to ... retrieve the associated Provenance and supporting records.,SHALL,Server,,false
|
|
53
|
-
hl7.fhir.us.davinci-pdex_2.0.0,45,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#constraining-data-based-upon-permissions-of-the-requestor,The FHIR Server SHALL constrain the data returned from the server to a requester based upon the access permissions of the requester.,SHALL,Server,,false
|
|
54
|
-
hl7.fhir.us.davinci-pdex_2.0.0,46,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#everything-operation,Health Plans SHOULD support the use of the $everything operation… defined in the FHIR R4 specification here: https://www.hl7.org/fhir/operation-patient-everything.html,SHOULD,Server
|
|
55
|
-
hl7.fhir.us.davinci-pdex_2.0.0,47,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#bulk-fhir-asynchronous-protocols,"Payer-to-Payer Data Exchange SHOULD support the use of Bulk FHIR methods, as defined in the HL7 FHIR [Bulk Data Access Implementation Guide](https://hl7.org/fhir/uv/bulkdata/authorization/).
|
|
56
|
-
hl7.fhir.us.davinci-pdex_2.0.0,48,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#data-mapping,Health Plans SHALL map claims and clinical information for a member to US Core v3.1.1 FHIR Resources based on R4.,SHALL,Server
|
|
57
|
-
hl7.fhir.us.davinci-pdex_2.0.0,49,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#data-mapping,"Where a US Core FHIR R4 Resource is not defined Health Plans SHALL map claims and clinical information to FHIR Profiles defined in this IG, or the Da Vinci HRex IG.",SHALL,Server
|
|
58
|
-
hl7.fhir.us.davinci-pdex_2.0.0,50,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#providing-data-in-sub-element-fields,"If a field is marked as required (cardinality n.., where n>0) the Health Plan SHALL populate the field.",SHALL,Server,,true
|
|
59
|
-
hl7.fhir.us.davinci-pdex_2.0.0,51,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#providing-data-in-sub-element-fields,"For a field specified as MUST SUPPORT and the cardinality is 0.., the Health Plan SHALL be capable of populating the field and do so if the relevant data exists.",SHALL,Server,,true
|
|
60
|
-
hl7.fhir.us.davinci-pdex_2.0.0,52,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#providing-data-in-sub-element-fields,"For a field specified as MUST SUPPORT and the cardinality is 0.., the Health Plan SHALL … [populate] the field ... if the relevant data exists.",SHALL,Server,,true
|
|
61
|
-
hl7.fhir.us.davinci-pdex_2.0.0,53,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#providing-data-in-sub-element-fields,"If a field is marked as MUST SUPPORT the receiver must be able to consume it without generating an error, unless the field is a sub-element of another field where that parent field does NOT have a minimum cardinality of 1 [or a Must Support Flag]. For example, if the parent field has a cardinality of “0..1” or “0..*” the sub-element field does not need to be populated.",SHALL,Client,,true
|
|
62
|
-
hl7.fhir.us.davinci-pdex_2.0.0,54,https://hl7.org/fhir/us/davinci-pdex/STU2/usecasescenarios.html#versioning-of-fhir-data,"If a payer chooses to support FHIR resource data versioning of related resource references, the referring resource **SHALL** use the vread format of reference: `[type]/[id]/_history/[vid]`",MAY,Server,,true
|
|
63
|
-
hl7.fhir.us.davinci-pdex_2.0.0,55,https://hl7.org/fhir/us/davinci-pdex/STU2/usecasescenarios.html#versioning-of-fhir-data,Supporting versioning of FHIR data implies supporting the [vread](https://www.hl7.org/fhir/http.html#vread) and [history](https://www.hl7.org/fhir/http.html#history) interactions in the FHIR specification.,MAY,Server,,true
|
|
64
|
-
hl7.fhir.us.davinci-pdex_2.0.0,56,https://hl7.org/fhir/us/davinci-pdex/STU2/StructureDefinition-pdex-priorauthorization.html,"Payers SHALL make available pending and active prior authorization decisions and related clinical documentation and forms for items and services, not including prescription drugs, including the date the prior authorization was approved, the date the authorization ends, as well as the units and services approved and those used to date, no later than one (1) business day after a provider initiates a prior authorization for the beneficiary or there is a change of status for the prior authorization.",SHALL,Server,,false
|
|
65
|
-
hl7.fhir.us.davinci-pdex_2.0.0,57,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#bulk-fhir-asynchronous-protocols,The request/retrieval [for the Payer-to-Payer Exchange] of data SHOULD use the [FHIR Bulk Data Patient Level Export](https://hl7.org/fhir/uv/bulkdata/OperationDefinition-patient-export.html).,SHOULD,Server,hl7.fhir.uv.bulkdata_2.0.0,
|
|
66
|
-
hl7.fhir.us.davinci-pdex_2.0.0,58,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#bulk-fhir-asynchronous-protocols,The request/retrieval [for the Payer-to-Payer Exchange] of data SHOULD use the … [Bulk Data Export Operation Request Flow](https://hl7.org/fhir/uv/bulkdata/export.html#bulk-data-export-operation-request-flow).,SHOULD,Server,hl7.fhir.uv.bulkdata_2.0.0,
|
|
49
|
+
- Bulk FHIR Asynchronous protocols.",SHALL,Client,,false,,
|
|
50
|
+
hl7.fhir.us.davinci-pdex_2.0.0,42,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#data-retrieval-methods,"Each of the above methods[, query all clinical resource individually, $everything, and $export,] SHALL support the retrieval of the profiles and resources [in the scope of the member health history, defined in the Server CapabilityStatement]",SHALL,Server,,false,,
|
|
51
|
+
hl7.fhir.us.davinci-pdex_2.0.0,43,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#query-all-clinical-resources-individually,Health Plans SHALL support search of a member’s clinical data.,SHALL,Server,,false,,
|
|
52
|
+
hl7.fhir.us.davinci-pdex_2.0.0,44,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#query-all-clinical-resources-individually,[Servers SHALL support] the _revInclude and _include parameters to ... retrieve the associated Provenance and supporting records.,SHALL,Server,,false,,
|
|
53
|
+
hl7.fhir.us.davinci-pdex_2.0.0,45,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#constraining-data-based-upon-permissions-of-the-requestor,The FHIR Server SHALL constrain the data returned from the server to a requester based upon the access permissions of the requester.,SHALL,Server,,false,,
|
|
54
|
+
hl7.fhir.us.davinci-pdex_2.0.0,46,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#everything-operation,Health Plans SHOULD support the use of the $everything operation… defined in the FHIR R4 specification here: https://www.hl7.org/fhir/operation-patient-everything.html,SHOULD,Server,,false,,
|
|
55
|
+
hl7.fhir.us.davinci-pdex_2.0.0,47,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#bulk-fhir-asynchronous-protocols,"Payer-to-Payer Data Exchange SHOULD support the use of Bulk FHIR methods, as defined in the HL7 FHIR [Bulk Data Access Implementation Guide](https://hl7.org/fhir/uv/bulkdata/authorization/) [[corrected link](https://hl7.org/fhir/uv/bulkdata/STU2/)].",SHOULD,Server,hl7.fhir.uv.bulkdata_2.0.0#Server,false,,
|
|
56
|
+
hl7.fhir.us.davinci-pdex_2.0.0,48,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#data-mapping,Health Plans SHALL map claims and clinical information for a member to US Core v3.1.1 FHIR Resources based on R4.,SHALL,Server,,false,,
|
|
57
|
+
hl7.fhir.us.davinci-pdex_2.0.0,49,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#data-mapping,"Where a US Core FHIR R4 Resource is not defined Health Plans SHALL map claims and clinical information to FHIR Profiles defined in this IG, or the Da Vinci HRex IG.",SHALL,Server,,true,,
|
|
58
|
+
hl7.fhir.us.davinci-pdex_2.0.0,50,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#providing-data-in-sub-element-fields,"If a field is marked as required (cardinality n.., where n>0) the Health Plan SHALL populate the field.",SHALL,Server,,true,,
|
|
59
|
+
hl7.fhir.us.davinci-pdex_2.0.0,51,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#providing-data-in-sub-element-fields,"For a field specified as MUST SUPPORT and the cardinality is 0.., the Health Plan SHALL be capable of populating the field and do so if the relevant data exists.",SHALL,Server,,true,,
|
|
60
|
+
hl7.fhir.us.davinci-pdex_2.0.0,52,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#providing-data-in-sub-element-fields,"For a field specified as MUST SUPPORT and the cardinality is 0.., the Health Plan SHALL … [populate] the field ... if the relevant data exists.",SHALL,Server,,true,,
|
|
61
|
+
hl7.fhir.us.davinci-pdex_2.0.0,53,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#providing-data-in-sub-element-fields,"If a field is marked as MUST SUPPORT the receiver must be able to consume it without generating an error, unless the field is a sub-element of another field where that parent field does NOT have a minimum cardinality of 1 [or a Must Support Flag]. For example, if the parent field has a cardinality of “0..1” or “0..*” the sub-element field does not need to be populated.",SHALL,Client,,true,,
|
|
62
|
+
hl7.fhir.us.davinci-pdex_2.0.0,54,https://hl7.org/fhir/us/davinci-pdex/STU2/usecasescenarios.html#versioning-of-fhir-data,"If a payer chooses to support FHIR resource data versioning of related resource references, the referring resource **SHALL** use the vread format of reference: `[type]/[id]/_history/[vid]`",MAY,Server,,true,,
|
|
63
|
+
hl7.fhir.us.davinci-pdex_2.0.0,55,https://hl7.org/fhir/us/davinci-pdex/STU2/usecasescenarios.html#versioning-of-fhir-data,Supporting versioning of FHIR data implies supporting the [vread](https://www.hl7.org/fhir/http.html#vread) and [history](https://www.hl7.org/fhir/http.html#history) interactions in the FHIR specification.,MAY,Server,,true,,
|
|
64
|
+
hl7.fhir.us.davinci-pdex_2.0.0,56,https://hl7.org/fhir/us/davinci-pdex/STU2/StructureDefinition-pdex-priorauthorization.html,"Payers SHALL make available pending and active prior authorization decisions and related clinical documentation and forms for items and services, not including prescription drugs, including the date the prior authorization was approved, the date the authorization ends, as well as the units and services approved and those used to date, no later than one (1) business day after a provider initiates a prior authorization for the beneficiary or there is a change of status for the prior authorization.",SHALL,Server,,false,,
|
|
65
|
+
hl7.fhir.us.davinci-pdex_2.0.0,57,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#bulk-fhir-asynchronous-protocols,The request/retrieval [for the Payer-to-Payer Exchange] of data SHOULD use the [FHIR Bulk Data Patient Level Export](https://hl7.org/fhir/uv/bulkdata/OperationDefinition-patient-export.html).,SHOULD,Server,"hl7.fhir.uv.bulkdata_2.0.0@272-274,277,280,283,286,289,292",false,,
|
|
66
|
+
hl7.fhir.us.davinci-pdex_2.0.0,58,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#bulk-fhir-asynchronous-protocols,The request/retrieval [for the Payer-to-Payer Exchange] of data SHOULD use the … [Bulk Data Export Operation Request Flow](https://hl7.org/fhir/uv/bulkdata/export.html#bulk-data-export-operation-request-flow).,SHOULD,Server,"hl7.fhir.uv.bulkdata_2.0.0@12-14,19-25,27-30,32-42,44,46,47,49-53,55-60,62-73,75-83,85-90,92-94,96-101,103,105-112,117,118,120-122,125,127-129,131-134,136-199,202-204,206-216,297-310",false,,
|
|
67
|
+
hl7.fhir.us.davinci-pdex_2.0.0,59,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"In the context of an HRex compliant IG, mustSupport on any data element **SHALL** be interpreted [to mean that] … Data Sources **SHALL** be capable of populating the data element when sharing resources compliant with the profile. I.e. the system must be able to demonstrate the population and sharing of the element",SHALL,Server,,false,,
|
|
68
|
+
hl7.fhir.us.davinci-pdex_2.0.0,60,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"In the context of an HRex compliant IG, mustSupport on any data element **SHALL** be interpreted [to mean that] … it is acceptable to omit the [must support] element if the [data source] system doesn't have values in a particular instance.",MAY,Server,,true,,
|
|
69
|
+
hl7.fhir.us.davinci-pdex_2.0.0,61,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"In the context of an HRex compliant IG, mustSupport on any data element **SHALL** be interpreted [to mean that] … Data Consumers **SHALL** be capable of processing resource instances containing the data elements without generating an error or causing the application to fail.",SHALL,Client,,false,,
|
|
70
|
+
hl7.fhir.us.davinci-pdex_2.0.0,62,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"In the context of an HRex compliant IG, mustSupport on any data element **SHALL** be interpreted [to mean that] … [i]f the minimum cardinality of an element is greater than 0 – i.e. the element is ‘required’, then the element **SHALL** be present in the instance",SHALL,Server,,true,,
|
|
71
|
+
hl7.fhir.us.davinci-pdex_2.0.0,63,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"In the context of an HRex compliant IG, mustSupport on any data element **SHALL** be interpreted [to mean that] … [i]f the minimum cardinality of an element is greater than 0 – i.e. the element is ‘required’, then the element ... **SHALL** have a value unless:
|
|
72
|
+
|
|
73
|
+
- The profile explicitly declares the dataAbsentReason extension or other extension for the element, in which case an extension can be present in place of the value. [or]
|
|
74
|
+
- The profile is inherited from U.S. Core, in which case a dataAbsentReason extension may be sent in place of the value even where dataAbsentReason is not explicitly declared in the profile.",SHALL,Server,,true,,
|
|
75
|
+
hl7.fhir.us.davinci-pdex_2.0.0,64,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"In the context of an HRex compliant IG, mustSupport on any data element **SHALL** be interpreted [to mean that] … Data Consumers **SHALL** interpret missing data elements within resource instances as data not being present in the Data Source’s systems or was not deemed to be shareable with the Data Consumer for privacy or other business reasons.",SHALL,Client,,true,,
|
|
76
|
+
hl7.fhir.us.davinci-pdex_2.0.0,65,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"In the context of an HRex compliant IG, mustSupport on any data element **SHALL** be interpreted [to mean that] … [w]here the value set for an element includes concepts such as “unknown”, “refused to answer”, “not available” or where dataAbsentReason is explicitly referenced in a profile, then Data Sources **SHALL** use these values/that extension to communicate the reason for missing data.",SHALL,Server,,true,,
|
|
77
|
+
hl7.fhir.us.davinci-pdex_2.0.0,66,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"In the context of an HRex compliant IG, mustSupport on any data element **SHALL** be interpreted [to mean that] … Data Consumers **SHALL** be able to process resource instances containing data elements that have extensions in place of a value where such extensions are declared as part of the profile.",SHALL,Client,,true,,
|
|
78
|
+
hl7.fhir.us.davinci-pdex_2.0.0,67,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,[Data sources] are free to include additional data [beyond the must support elements],MAY,Server,,false,,
|
|
79
|
+
hl7.fhir.us.davinci-pdex_2.0.0,68,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,[R]eceivers **SHOULD NOT** reject instances that contain unexpected [non-must support] data elements if those elements are not [modifier elements](http://hl7.org/fhir/R4/conformance-rules.html#isModifier).,SHOULD NOT,Client,,true,,
|
|
80
|
+
hl7.fhir.us.davinci-pdex_2.0.0,69,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"[Data Sources] should be aware that they can't count on receivers storing, processing or doing anything other than ignoring data that is not marked as mustSupport.",SHOULD,Server,,true,Not Verifiable,Can only be tested in the context of a specific trading partner
|
|
81
|
+
hl7.fhir.us.davinci-pdex_2.0.0,70,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"Many of the profiles in this guide reference other FHIR resources that are US Core profiles. This is defined in the formal profile definitions. For example, US Core Patient. For any other references not formally defined in a US Core profiles, the referenced resource **SHOULD** be a US Core profile if a US Core profile exists for the resource type.",SHOULD,Server,,true,,
|
|
82
|
+
hl7.fhir.us.davinci-pdex_2.0.0,71,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#notes,The response [from a server] from a failed $member-match … [SHALL be] “422 Unprocessable Entity Status Code”.,SHALL,Server,,true,,
|
|
83
|
+
hl7.fhir.us.davinci-pdex_2.0.0,72,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#notes,After a successful $member-match the requesting system SHALL then use the UMB provided by the target payer in the Patient.identifier field in any subsequent transactions with the same system.,SHALL,Client,,,,
|
|
84
|
+
hl7.fhir.us.davinci-pdex_2.0.0,73,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#notes,"If the requesting system [of a $member-match request] was a payer with coverage for the member, the receiving system SHOULD create a linkage between their own member information and the Coverage provided by the requesting system.",SHOULD,Server,,,,
|
|
85
|
+
hl7.fhir.us.davinci-pdex_2.0.0,74,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#notes,This [coverage] linkage can be used [by the receiver ofa $member-match request] to support subsequent queries by establishing a known ‘reason’ for [a know requestor to be] accessing a member’s information.,SHOULD,Server,,,,
|
|
86
|
+
hl7.fhir.us.davinci-pdex_2.0.0,75,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#notes,"For privacy reasons, the ‘CoverageToLink’ [element in $member-match request] SHOULD NOT include any data elements not marked as mustSupport in the Coverage profile.",SHOULD NOT,Client,,,,
|
|
87
|
+
hl7.fhir.us.davinci-pdex_2.0.0,76,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#resolving-parameter-references,"Those references [to a Patient instance in the Coverage and Consent resources of the $member-match operation] SHALL be ‘local’ references (i.e. starting with “Patient/” rather than “http”),",SHALL,Client,,,,
|
|
88
|
+
hl7.fhir.us.davinci-pdex_2.0.0,77,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#resolving-parameter-references,"Those references [to a Patient instance in the Coverage and Consent resources of the $member-match operation] SHALL be resolved to the parameter with the name “MemberPatient”,",SHALL,Server,,,,
|
|
89
|
+
hl7.fhir.us.davinci-pdex_2.0.0,78,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#resolving-parameter-references,"Those references [to a Patient instance in the Coverage and Consent resources of the $member-match operation] and SHALL refer to the same id [as the ""MemberPaitent"" parameter].",SHALL,Client,,,,
|
|
90
|
+
hl7.fhir.us.davinci-pdex_2.0.0,79,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#member-matching-logic,[T]he algorithms used [to match patient records for the $member-match operation] should be robust,SHOULD,Server,,,,
|
|
91
|
+
hl7.fhir.us.davinci-pdex_2.0.0,80,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#member-matching-logic,Servers SHALL monitor for and take measures to prevent brute force attacks [using $member-match] where the same or similar set of demographics are repeatedly searched with differing card information in an attempt to achieve a match when the card information is unknown.,SHALL,Server,,,,
|
|
92
|
+
hl7.fhir.us.davinci-pdex_2.0.0,81,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#member-matching-logic,[For $member-match a] maximum of a SINGLE unique match SHALL be returned.,SHALL,Server,,,,
|
|
93
|
+
hl7.fhir.us.davinci-pdex_2.0.0,82,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#member-matching-logic,[For $member-match n]o match SHALL return a 422 status code.,SHALL,Server,,,,
|
|
94
|
+
hl7.fhir.us.davinci-pdex_2.0.0,83,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#member-matching-logic,[For $member-match m]ultiple matches SHALL return a 422 status code.,SHALL,Server,,,,
|
|
95
|
+
hl7.fhir.us.davinci-pdex_2.0.0,84,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#member-matching-logic,"[T]he specification requires a [client] health plan to provide demographic information (name, date of birth, gender) and identification details that would be present on a member’s health plan insurance card with a [$member-match] request.",SHALL,Client,,,,
|
|
96
|
+
hl7.fhir.us.davinci-pdex_2.0.0,85,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#consent,"If the consent [provided on a $member-match request] gets revoked on the data comsumer’s side, then that system simply stops requesting information.",SHALL,Client,,,,
|
|
97
|
+
hl7.fhir.us.davinci-pdex_2.0.0,86,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#consent,"If the consent [provided on a $member-match request] is revoked on the data source’s side, then it simply stops sending information in response to a request.",SHALL,Server,,,,
|
|
98
|
+
hl7.fhir.us.davinci-pdex_2.0.0,87,https://www.hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support,"For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
|
|
99
|
+
|
|
100
|
+
US Core Responders **SHALL** be capable of populating all data elements as part of the query results specified by the [US Core Server Capability Statement](https://hl7.org/fhir/us/core/STU3.1.1/CapabilityStatement-us-core-server.html).",SHALL,Server,,false,,
|
|
101
|
+
hl7.fhir.us.davinci-pdex_2.0.0,88,https://www.hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support,"For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
|
|
102
|
+
|
|
103
|
+
US Core Requestors **SHALL** be capable of processing resource instances containing the data elements without generating an error or causing the application to fail.",SHALL,Client,,false,,
|
|
104
|
+
hl7.fhir.us.davinci-pdex_2.0.0,89,https://www.hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support,"For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
|
|
105
|
+
|
|
106
|
+
In situations where information on a particular data element is not present and the reason for absence is unknown, US Core Responders SHALL NOT include the data elements in the resource instance returned as part of the query results.",SHOULD,Server,,false,,
|
|
107
|
+
hl7.fhir.us.davinci-pdex_2.0.0,90,https://www.hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support,"For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
|
|
108
|
+
|
|
109
|
+
When information on a particular data element is not present, and the reason for absence is unknown, US Core Responders **SHALL NOT** include the data elements in the resource instance returned as part of the query results.",SHALL NOT,Server,,true,,
|
|
110
|
+
hl7.fhir.us.davinci-pdex_2.0.0,91,https://www.hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support,"For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
|
|
111
|
+
|
|
112
|
+
When querying US Core Responders, US Core Requestors **SHALL** interpret missing data elements within resource instances as data not present in the US Core Responder’s system.",SHALL,Client,,false,,
|
|
113
|
+
hl7.fhir.us.davinci-pdex_2.0.0,92,https://www.hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support,"For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
|
|
114
|
+
|
|
115
|
+
In situations where information on a particular data element is missing and the US Core Responder knows the precise reason for the absence of data, US Core Responders **SHALL** send the reason for the missing information using values (such as nullFlavors) from the value set where they exist or using the dataAbsentReason extension.",SHALL,Server,,true,,
|
data/lib/davinci_pdex_test_kit/requirements/generated/pdex_payer_client_requirements_coverage.csv
ADDED
|
@@ -0,0 +1,29 @@
|
|
|
1
|
+
Req Set,ID,URL,Requirement,Conformance,Actors,Conditionality,Not Tested Reason,Not Tested Details,Da Vinci PDex Payer Client Test Suite Short ID(s),Da Vinci PDex Payer Client Test Suite Full ID(s)
|
|
2
|
+
hl7.fhir.us.davinci-pdex_2.0.0,4,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"For profiles defined in [US Core and referenced by PDex], the meaning of Must Support [for Clients] is established in [the US Core IG [must support section](https://hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support)].",SHALL,Client,false,,,3.02,pdex_payer_client-pdex_client_visual_inspection_and_attestation-pdex_client_must_support_interpretation_test
|
|
3
|
+
hl7.fhir.us.davinci-pdex_2.0.0,6,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"For profiles defined in [DaVinci HRex and referenced by PDex], the meaning of Must Support [for Clients] is established in [the HRex IG [Conformance section](https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html)].",SHALL,Client,false,,,3.02,pdex_payer_client-pdex_client_visual_inspection_and_attestation-pdex_client_must_support_interpretation_test
|
|
4
|
+
hl7.fhir.us.davinci-pdex_2.0.0,8,https://hl7.org/fhir/us/davinci-pdex/STU2/index.html#must-support,"[For profiles defined in the PDex IG, Clients SHALL follow] Must Support requirements … [from] the US Core Implementation Guide [[must support section](https://hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support)].",SHALL,Client,false,,,3.02,pdex_payer_client-pdex_client_visual_inspection_and_attestation-pdex_client_must_support_interpretation_test
|
|
5
|
+
hl7.fhir.us.davinci-pdex_2.0.0,10,"https://hl7.org/fhir/us/davinci-pdex/STU2/overview.html#oauth20-or-smart-on-fhir-member-authorized-exchange,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.html,https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api",The member SHALL authenticate using credentials that have been issued by or are recognized and accepted by the Health Plan. These are typically the member’s customer portal credentials for accessing the health plan.,SHALL,Client,false,,,3.01,pdex_payer_client-pdex_client_visual_inspection_and_attestation-pdex_member_authentication_test
|
|
6
|
+
hl7.fhir.us.davinci-pdex_2.0.0,27,"https://hl7.org/fhir/us/davinci-pdex/STU2/pdeximplementationactorsinteractionsdatapayloadsandmethods.html#oauth20-and-fhir-api,https://hl7.org/fhir/us/davinci-pdex/STU2/member-authorizedoauth2exchange.htm",The requesting application [authorized to access member information] SHALL use the access token to access the Health Plan’s secure FHIR API to download the information that the Application is allowed to access.,SHALL,Client,false,,,2.1.01,pdex_payer_client-payer_to_payer_workflow-pdex_client_workflow_interaction-pdex_client_workflow_interaction
|
|
7
|
+
hl7.fhir.us.davinci-pdex_2.0.0,28,https://hl7.org/fhir/us/davinci-pdex/STU2/handlingdataprovenance.html#handling-data-provenance,Health Plans SHALL accept and retain Provenance records received with data based on Member-authorized Payer-to-Payer exchange.,SHALL,Client,false,,,3.04,pdex_payer_client-pdex_client_visual_inspection_and_attestation-pdex_accept_retain_provenance_test
|
|
8
|
+
hl7.fhir.us.davinci-pdex_2.0.0,29,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#member-match-with-consent,Each [data] retrieval ... SHALL be preceded by the use of the ... [HRex [$member-match](https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html)] interaction to match a member and provide consent.,SHALL,Client,false,,,2.6.01,pdex_payer_client-payer_to_payer_workflow-member_match_validation-pdex_initial_member_match_validation
|
|
9
|
+
hl7.fhir.us.davinci-pdex_2.0.0,41,https://hl7.org/fhir/us/davinci-pdex/STU2/payertopayerexchange.html#data-retrieval-methods,"Once Health Plans have completed the Member Access stage of the Exchange the requesting Health Plan SHALL utilize the access token returned from the Member Access step to request/retrieve data using one of the following three methods:
|
|
10
|
+
- Query all clinical resource individually
|
|
11
|
+
- $patient-everything operation
|
|
12
|
+
- Bulk FHIR Asynchronous protocols.",SHALL,Client,false,,,2.1.01,pdex_payer_client-payer_to_payer_workflow-pdex_client_workflow_interaction-pdex_client_workflow_interaction
|
|
13
|
+
hl7.fhir.us.davinci-pdex_2.0.0,53,https://hl7.org/fhir/us/davinci-pdex/STU2/datamapping.html#providing-data-in-sub-element-fields,"If a field is marked as MUST SUPPORT the receiver must be able to consume it without generating an error, unless the field is a sub-element of another field where that parent field does NOT have a minimum cardinality of 1 [or a Must Support Flag]. For example, if the parent field has a cardinality of “0..1” or “0..*” the sub-element field does not need to be populated.",SHALL,Client,true,,,3.03,pdex_payer_client-pdex_client_visual_inspection_and_attestation-pdex_must_support_sub_element_handling_test
|
|
14
|
+
hl7.fhir.us.davinci-pdex_2.0.0,61,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"In the context of an HRex compliant IG, mustSupport on any data element **SHALL** be interpreted [to mean that] … Data Consumers **SHALL** be capable of processing resource instances containing the data elements without generating an error or causing the application to fail.",SHALL,Client,false,,,"",""
|
|
15
|
+
hl7.fhir.us.davinci-pdex_2.0.0,64,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"In the context of an HRex compliant IG, mustSupport on any data element **SHALL** be interpreted [to mean that] … Data Consumers **SHALL** interpret missing data elements within resource instances as data not being present in the Data Source’s systems or was not deemed to be shareable with the Data Consumer for privacy or other business reasons.",SHALL,Client,true,,,"",""
|
|
16
|
+
hl7.fhir.us.davinci-pdex_2.0.0,66,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,"In the context of an HRex compliant IG, mustSupport on any data element **SHALL** be interpreted [to mean that] … Data Consumers **SHALL** be able to process resource instances containing data elements that have extensions in place of a value where such extensions are declared as part of the profile.",SHALL,Client,true,,,"",""
|
|
17
|
+
hl7.fhir.us.davinci-pdex_2.0.0,68,https://hl7.org/fhir/us/davinci-hrex/STU1/conformance.html,[R]eceivers **SHOULD NOT** reject instances that contain unexpected [non-must support] data elements if those elements are not [modifier elements](http://hl7.org/fhir/R4/conformance-rules.html#isModifier).,SHOULD NOT,Client,true,,,"",""
|
|
18
|
+
hl7.fhir.us.davinci-pdex_2.0.0,72,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#notes,After a successful $member-match the requesting system SHALL then use the UMB provided by the target payer in the Patient.identifier field in any subsequent transactions with the same system.,SHALL,Client,,,,"",""
|
|
19
|
+
hl7.fhir.us.davinci-pdex_2.0.0,75,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#notes,"For privacy reasons, the ‘CoverageToLink’ [element in $member-match request] SHOULD NOT include any data elements not marked as mustSupport in the Coverage profile.",SHOULD NOT,Client,,,,"",""
|
|
20
|
+
hl7.fhir.us.davinci-pdex_2.0.0,76,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#resolving-parameter-references,"Those references [to a Patient instance in the Coverage and Consent resources of the $member-match operation] SHALL be ‘local’ references (i.e. starting with “Patient/” rather than “http”),",SHALL,Client,,,,"",""
|
|
21
|
+
hl7.fhir.us.davinci-pdex_2.0.0,78,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#resolving-parameter-references,"Those references [to a Patient instance in the Coverage and Consent resources of the $member-match operation] and SHALL refer to the same id [as the ""MemberPaitent"" parameter].",SHALL,Client,,,,"",""
|
|
22
|
+
hl7.fhir.us.davinci-pdex_2.0.0,84,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#member-matching-logic,"[T]he specification requires a [client] health plan to provide demographic information (name, date of birth, gender) and identification details that would be present on a member’s health plan insurance card with a [$member-match] request.",SHALL,Client,,,,"",""
|
|
23
|
+
hl7.fhir.us.davinci-pdex_2.0.0,85,https://hl7.org/fhir/us/davinci-hrex/STU1/OperationDefinition-member-match.html#consent,"If the consent [provided on a $member-match request] gets revoked on the data comsumer’s side, then that system simply stops requesting information.",SHALL,Client,,,,"",""
|
|
24
|
+
hl7.fhir.us.davinci-pdex_2.0.0,88,https://www.hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support,"For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
|
|
25
|
+
|
|
26
|
+
US Core Requestors **SHALL** be capable of processing resource instances containing the data elements without generating an error or causing the application to fail.",SHALL,Client,false,,,"",""
|
|
27
|
+
hl7.fhir.us.davinci-pdex_2.0.0,91,https://www.hl7.org/fhir/us/core/STU3.1.1/general-guidance.html#must-support,"For querying and reading US Core Profiles, Must Support on any profile data element **SHALL** be interpreted as follows…:
|
|
28
|
+
|
|
29
|
+
When querying US Core Responders, US Core Requestors **SHALL** interpret missing data elements within resource instances as data not present in the US Core Responder’s system.",SHALL,Client,false,,,"",""
|