Payer-to-Payer · CMS-0057F · 42 CFR 422.119(c) · Da Vinci PDex 2.1.0
Payer-to-Payer
LiveBulk FHIR transfer between payers on member enrollment. Member-match establishes identity, consent preserves opt-out, and PDex bulk export delivers the full clinical and claims history.
Exchange flow
Three phases in sequence — match, consent, export.
Member match
$member-match resolves the member across payer systems using demographic data and prior coverage identifiers. Response includes a member ID valid for subsequent calls.
Consent check
The receiving payer verifies the member has not opted out of P2P data exchange. Opt-out records are stored in Consent resources.
Bulk export
$export pulls the full member history as NDJSON. Files are available at a status endpoint; each file is a line-delimited list of FHIR resources.
Endpoints
FHIR operations used in the P2P exchange flow.
/Patient/$member-matchResolve a member's identity at the prior payer.
/Group/$exportAsync bulk FHIR export of attributed member history.
/Patient/{id}/everythingFull member history for a matched patient.
/ConsentRecord member opt-out consent for data exchange.