x 2022

Short Description

Payer Data Exchange (PDex) is preparing an update to the STU2 version of the IG. This will incorporate changes to support anticipated regulatory changes related to Burden Reduction and Payer-Provider Bulk Exchange. This track will be testing out the changes to the IG made for the post STU2 Ballot Submission planned for early 2023. 

PDex Formulary Break-out - Implementer support Office Hours

Long Description

Testing of changes to the Payer Data Exchange IG that are planned for the post-STU2 version of the guide.  With an impending NPRM that may address Payer-to-Payer Exchange and Payer-Provider Exchange this will be an opportunity for payers to test their exchange solutions with other payers. 

PDex Formulary Break-out - Implementer support Office Hours


Test an Implementation Guide

Track Prerequisites

PDex IG - Payer to Payer Exchange

Review the following Page in the Continuous Integration Build: Payer-to-Payer Exchange

Read up about mTLS. It is used to setup access to Dynamic Client Registration in OAuth2.0. Here is an article that may help (You can search for mTLS in a search engine for other explanations): https://codeburst.io/mutual-tls-authentication-mtls-de-mystified-11fa2a52e9cf  

FHIR Client

Come prepared to interact with a FHIR Server.  This can be accomplished with an application that can be configured or coded to make FHIR RESTful calls.  See the "Step by step tutorial and sample projects" under the Helpful Links below for an example of how to do this use Postman.

FHIR Server

Come prepared for other FHIR Clients to be able to interact with your FHIR Server.

Track Lead(s)

Mark Scrimshire <mark.scrimshire@onyxhealth.io>; Bob Dieterle <rdieterle@enablecare.us>; Co-lead : Ezequiel (EZ) Morales <ezequiel.morales@evernorth.com>

Track Lead Email(s)

mark.scrimshire@onyxhealth.iordieterle@enablecare.us; ezequiel.morales@evernorth.com

Specification Information

CMS 2022 – 07 Da Vinci Payer Data Exchange (PDex) & Drug Formulary

mTLS endpoint directory: https://github.com/rdieterle2/Payer-Payer

Note: the directory has only the example from the PDex IG loaded – please load compliant examples based the plan for the Git directory

Call for participants

Payers, Vendors and Providers

Zulip stream

PDex: https://chat.fhir.org/#narrow/stream/235286-Da-Vinci.20PDex

Track Kick off Call

Kick-off call will take place on 9/9/2022 during the regular 2:00 PM ET PDex/Formulary Workgroup call; 

Meeting recording: https://hl7-org.zoom.us/rec/share/CQ_BgP_oO3T-gkd6VNFmYiI1CyIjsoJkCBgf8SS03golHI7R5OZc-dT1M7cjCxQ.pLtQR2tF4-5_PG1R 

Clinical Input Required?Payers and Providers using US Core 3.1.1
Related Tracks?Member Attribution - for Payer-Provider exchange
Helpful Links

Here are some links to assist implementers:

Testing Scenario:

Use Case 1 - Payer-to-Payer

System roles:

  • Payer acting as Server
  • Payer acting as Client

Payers will need to register an mTLS endpoint into a GitHub repository to enable mTLS endpoint discovery.

Role 1 Name: Establish mTLS connection


Payer1 will search for Payer2 in mTLS endpoint repository

Payer1 will request connection with Payer2

Payer2 will lookup  Payer1 in mTLS endpoint repository to confirm legitimate request

Payer2 will reciprocate connection back to Payer1 to establish mTLS connectivity. 

Scenario Step 1 Name


Payer1 and Payer2 successfully connect via mTLS

Precondition: Success Criteria: 

  • Payer1 successfully makes a request to OAuth2.0 Dynamic Client Registration Protocol endpoint and relieves client credentials that enable a $member-match operation to be requested.

Success Criteria:  

Payer1 reaches $member-match operation with valid client credentials issued by DCRP endpoint via mTLS connection.

Bonus point:

Successful $member-match operation



Security and Privacy Considerations:

  • mTLS will be established to enable access to OAuth2.0 DCRP endpoint.

Use Case 2 - Payer Provider (Provisional)

System roles:

  • Payer acting as Server
  • Provider acting as Client

Providers will need to be registered with Payer with appropriate User level credentials to access the required FHIR APIs and Operations

Role 1 Name: Get Patient info for Current Patient Roster


  • Provider will submit a list of patients to Payer to retrieve patient clinical data
  • Provider will submit a list of patients to Payer to retrieve data for Patients since a previous download date
  • Payer will validate list to ensure all members are attributed to Provider

Precondition: Success Criteria: 

  • Provider successfully downloads data from Payer for a group of members/patients using bulk async protocols

Bonus point:

  • Provider successfully downloads a subset of members from their attributed list
  • Payer and Provider successfully negotiate updates to attributed member list(s)



Security and Privacy Considerations:

  • TBD

Use Case 3 - Formulary Bulk Export

System roles:

  • Payer/PBM acting as Server
  • Third-Party App acting as Client

Role 1 Name: Server 

Server provides $export operation to enable one or more Formularies to be exported.

Role 2 Name: Client

Client makes $export request to download formulary.

Da Vinci Formulary STU2 RI with Bulk.postman_collection.json

1 Comment

  1. For those interested in using the Touchstone Proxy feature, please watch the following videos:

    VIDEO 1: FHIR Testing - Using Touchstone's Peer-to-Peer/Proxy Features to Capture and Test FHIR Exchanges (https://youtu.be/08QofGL2gZE)Video 2: FHIR Test Server Setup for Peer-to-Peer/Proxy Testing in Touchstone & Connectathon Manager (ConMan) (https://www.youtube.com/watch?v=Xt9Vre-YsbU)

    Set up and walk-through of AEGIS's Touchstone Testing Platform operating as a proxy using the Peer-to-Peer feature to test and capture FHIR exchanges between a client and server with and without OAuth by Richard Ettema, Lead Developer and Sr. Technical Architect, AEGIS’ Touchstone Testing Platform.

    High-level walk-through of FHIR Test Server set up and configuration using AEGIS' Touchstone Testing Platform and where to find the proxy data used in Conman Connectathon Manager to advertise the proxy connection for Peer-to-Peer/Proxy Testing by FHIR Clients at HL7 FHIR Connectathons and related events, by Wendy Gereke, Engagement Manager, AEGIS’, Inc.