Data Associated with Payers Meeting the Administrative Financial

Data Associated with Payers Meeting the Administrative / Financial and Clinical Requirements of the Interoperability Exchange Payer Clinical Systems (From Providers / EHRs) Clinical Provider data from CDAs and other sources Laboratory (e. g. Quest/ Lab. Corp) Payer Claims Systems Payer Data Claims $ Claims EOB Immunizations ! Alerts (e. g. ADT) System of Record PBM (meds) Claims – Clinical Data Claims clinical data (diagnosis, procedure, drug codes) to PDex EXCLUDES: Claims Financial data Claims – Financial Data DATA RECIPIENT Da Vinci Payer Data Exchange (PDex) • Payer Data Exchange (PDex) (All USCDI, where possible) ‒ Location ‒ Patient ‒ Immunization ‒ Practitioner ‒ Medication ‒ Practitioner Role ‒ Diagnostic Report ‒ Encounter ‒ Document Reference ‒ Condition ‒ Provenance (PDex Profile) ‒ Procedure ‒ Coverage (PDex Profile) ‒ Observation ‒ Organization Data is available for interoperable exchange regardless of current member status. Date of Service 1/1/2016 going forward CMS Patient API (PDex + BB) (2021) Provider EHR API (PDex) (2021) Payer-Payer API (*PDex) (2022) * Payer to Payer Clinical Data may be in PDex or any other format CARIN Alliance Consumer Directed Payer Data Exchange (CARIN BB) • Explanation of Benefit (EOB) Resource ‒ Includes claim clinical data, adjudication and other financial information • CARIN BB reference resources ‒ Practitioner ‒ Coverage ‒ Practitioner Role ‒ Patient ‒ Location ‒ Organization Data is available for interoperable exchange for current members. Date of Service 1/1/2016 going forward