Data Integration Reference
What you send Payerbox. For each dataset, the columns to deliver and the FHIR they become.
Data conventions
| Rule | Detail |
|---|---|
| Format | Agreed per engagement. If you deliver CSV: UTF-8, comma-delimited, first row is the headers, named exactly as in the tables. |
| Delivery | Arranged per engagement. PHI: encrypted in transit and at rest under the executed BAA. |
| History (USCDI feed) | Date of service on or after January 1, 2016. Send active and historical records; the status columns mark which is which. |
| Code systems | Every coded column has a companion _system column holding the code system URI: substance_code with substance_system, vaccine_code with vaccine_system, and so on. Leave it blank to accept the default named in that column's row. |
Built on US Core
USCDI lists the data classes and the elements in each. US Core maps every element onto a FHIR element. Payerbox pins US Core 6.1.0, realizing USCDI v3 (Implementation Guides). The USCDI feed targets USCDI v3.1.
The other feeds build on their own implementation guides, listed below, and some of them lean on the USCDI feed. Claims is the clearest case: every ExplanationOfBenefit references the Patient, Coverage, Organization and Practitioner built from the USCDI datasets, and CARIN Blue Button types those references against its own profiles, which derive from US Core and add constraints. The one that shapes a column: C4BB Patient requires a member number identifier, which US Core does not, so a delivery that includes claims must carry one on every row of Patient Demographics.
Feeds
| Feed | Built on | Datasets |
|---|---|---|
| USCDI v3.1 Data | US Core 6.1.0 | 24 |
| Provider Directory | PDex Plan-Net STU 1.2.0 | 4 |
| Claims | CARIN Blue Button STU 2.1.0 | 10 |
| Prior Authorizations | Da Vinci PDex STU 2.1.0 | 3 |
| Drug Formulary | PDex US Drug Formulary STU 2.1.0 | 16 |
| Member Consent | HRex STU 1.1.0, PDex STU 2.2.0 | 3 |