Short Description

A Da Vinci combined Track that covers the majority of Guides that address the CMS Patient Access API requirements of the Interoperability rule: Payer Data Exchange, Drug Formulary and Provider/Pharmacy Directory. 

Long Description

The Patient Access API requirement of the CMS Interoperability Rule deadline is July 1. This Da Vinci track brings together the Payer Data Exchange, Drug Formulary and Plan-Net IGs that are cited by CMS to enable payers to comply with the rule. For payers this is an opportunity to test out their APIs with reference applications. For Consumer applications this is an opportunity to connect with payers and test your apps against the Patient Access APIs.


One focus for this track will be test the interaction between the CARIN Blue Button IG and the Da Vinci IGs where resources such as claims and encounters could link with reference resources in the Formulary or Provider Directory IGs. 

Submitting Work Group/Project/Accelerator/Affiliate/Implementer Group  

This track is organized by the HL7 Da Vinci Accelerator Project. The IGs are managed through the Financial Management Work group.

Track Lead(s)

Mark Scrimshire (onyx, Dave Hill, Saul Kravitz, Corey Spears and Sean Mahoney (MITRE)
Track Lead Email(s);;;;

Related Tracks

CARIN Blue Button IG, Da Vinci Health Record Exchange, Da. Vinci PCDE

FHIR Version


Specification(s) this track uses

US Core STU3 3.1.1

Da Vinci Payer Data Exchange STU1 1.0.0

DaVinci Payer Data Exchange (PDex) US Drug Formulary STU 1.0.1

DaVinci PDEX Plan Net STU1 1.0.0

Artifacts of focus

US Core Encounter, PDex Coverage, CARIN BB ExplanationOfBenefit, Plannet Practitioner, Plannet Organization, Planned Location, Formulary Coverage Plan

Expected participants

Payers, Technology Vendors and Consumer Application Developers

Zulip stream Vinci PDex

Track Details

System roles:

Payer FHIR API with member Authentication via SMART-on-FHIR App Launch Framework

Payer Open API for Provider-Directory API

Consumer App that can request access for member-mediated exchange via SMART-on-FHIR App Launch Framework

All testers are recommended to preparer the Connectathon in advance. 

A Reference Server will be available, as will reference applications. 

Preparation of suitable coordinated test data across claims, clinical and reference resources is recommended.

Role 1 Name: Referential consistency


Consumer App to connect to Patient Access API and Provider-Directory API and be able to reference Practitioner information from claim into the provider-directory provided by the same payer.

Scenario Step 1 Name


  • Consumer App connects to Patient Access API and enables member authentication and access to secured Patient Access API data.
  • Consumer App is able to retrieve Provider Directory information for practitioner and organization resources identified in a claim or clinical record.

Precondition: Success Criteria: 

  • Success retrieval of claim or clinical record and detailed reference information for Practitioner/Organization.

Success Criteria:  

Bonus point:

If Payer API configuration can demonstrate successful integration between data sources served up by independent FHIR Servers. e.g. Medical data and PBM data on separate servers and business logic is in effect to connect data related to a single member across the servers. 


Touchstone scripts are available for each IG

Security and Privacy Considerations:

Patient Access API is protected by SMART-on-FHIR App Launch Framework (OpenID Connect/OAuth2.0 protocols).

Welcome Session: