Submitting WG/Project/Implementer Group

Justification and Objectives

This track will use what version of FHIR.

Clinical input requested (if any)

Related tracks

Proposed Track Lead

Expected participants

Track Orientation

A webinar will be hosted on 11/20/2018 3pm ET as part of the Member Attribution Public Call to share further participation information about this track.

System Roles

Producer Role (Server)

Consumer Role (Client)


Scenarios

Scenario 1: Consumer (Provider Organization) discovers the applicable Group Resource in Producers (Payer Organization) system

Ability for a Provider organization to discover the Group Resource representing the Member Attribution List that is applicable to their specific organization.

For example, Multicare would like to know which Group Resource in Cambi'a System is applicable for their organization using their NPI or TIN information.

Precondition:

API: 

GET <Server Base URL>/Group?identifier:oftype=http://terminology.hl7.org/CodeSystem/v2-0203|NPI|ExampleNPI&identifier:oftype=http://terminology.hl7.org/CodeSystem/v2-0203|TAX|ExampleTIN

Success Criteria:


Scenario 2: Consumer (Provider Organization) Requests the Member Attribution List from the Producer (Payer Organization)

Ability for a Provider organization to request the full Member Attribution List that is applicable to their specific organization. Note: The request has to be accepted by the Payer and eventually a Member Attribution List would be made available. This is an asynchronous request following Bulk Data IG specifications.

For example, Multicare would like to request the Member Attribution List from Cambia for a specific contract. 

Precondition: 

API

GET or POST <Server Base URL>/Group/[Group id]/$export?_type=Patient,Practitioner,PractitionerRole,Organization,Location,Coverage,RelatedPerson

Success Criteria:


Scenario 3: Consumer polls the Content Location for Request Completion and Member Attribution List data location. 

Ability for a Provider organization to poll the Content Location received as part of Scenario 2 to determine completion status of the Member Attribution List Request issued in Scenario 2 and once completed identify the location of the files that represent the Member Attribution List.

For example, Multicare would poll the content location received as part of the response in Scenario 2. 

Pre condition

API

GET <Content Location from Scenario 2 response>

Success Criteria:


Scenario 4: Consumer retrieves the files representing the Member Attribution List

Ability for a Provider organization to retrieve each of the files that represent the Member Attribution List.

For example, Multicare retrieves each of the NDJSON files representing the Member Attribution List.

Pre condition:

API

GET <File URL for each Resource identified in Scenario 3 completion response>

Success Criteria:


TestScript(s)

Indicate any test scripts that will be used to help verify system behavior

Security and Privacy Considerations