Member Consent | Payerbox Docs

Datasets

A member opts out of Provider Access and opts in to Payer-to-Payer. Each decision becomes one FHIR Consent. Whoever holds the record delivers this feed.

Dataset	Target profile
`provider_access_opt_outs`	PDex Provider Consent, read by `$provider-member-match` and by every Provider Access export
`payer_to_payer_opt_ins`	HRex Consent, the member authorization used to build outbound Payer-to-Payer requests
`previous_coverages`	HRex Coverage: which payer to ask, and about whom

Data conventions

Rule	Detail
History	A decision is never edited. A change of mind is a new row with its own `record_id` and a later `captured_at`; the latest `captured_at` per member and switch is the state in force.
Freshness	Within one business day of capture. Faster delivery, including event-driven, per engagement.
Delivery	One backfill of every decision on file, then deltas with rows new since your last successful load.
Keys	`record_id` is your consent system's identifier for the decision, unique across the feed.
References	`patient_identifier` from `patients`, `signer_related_person_id` from `related_persons`, `*_document_id` from `documents`.
Documents	The signed form and a representative's document of authority travel in `documents`, referenced from here by key. The opt-in cannot be built without its signed form: HRex Consent requires a source document.
Dates	`date` columns are `YYYY-MM-DD`. `datetime` columns are ISO 8601 with a timezone offset.

provider_access_opt_outs

One row per decision on the Provider Access switch.

Column	Required	Format / values	Example
`record_id`	Yes	your identifier for this decision	`PAC-000117`
`patient_identifier`	Yes	patient key from `patients`	`MRN-4471903`
`choice`	Yes	`opt-out`, `share` (opt back in)	`opt-out`
`captured_at`	Yes	datetime the decision was made	`2026-11-03T14:22:00-05:00`
`effective_start`	Yes	date the decision takes effect	`2026-11-03`
`signer_type`	Yes	`member`, `personal-representative`	`member`
`signer_related_person_id`	If `personal-representative`	key from `related_persons`	`RP-88012`
`authority_document_id`	If `personal-representative`	key from `documents`; power of attorney, guardianship order or equivalent	`DOC-55190`
`signed_form_document_id`	If available	key from `documents`	`DOC-55191`
`last_updated`	Yes	datetime this row last changed in your system	`2026-11-03T14:22:00-05:00`
`is_deleted`	If retracting	`true` retracts a row delivered in error

opt-out becomes provision.type = deny, share becomes permit. captured_at is Consent.dateTime, effective_start is provision.period.start, signer_type decides whether performer is the Patient or the RelatedPerson. The rest of the profile is filled from plan configuration, not from the row: the two category codes (IDSCL and the PDex API purpose provider-access), your Organization as organization and as the source actor, provision.action = disclose, and policyRule = cric, the value the profile fixes. The check the operation runs is documented with the operation.

payer_to_payer_opt_ins

One row per decision on the Payer-to-Payer switch. One election covers previous and concurrent payers.

Column	Required	Format / values	Example
`record_id`	Yes	your identifier for this decision	`P2P-000342`
`patient_identifier`	Yes	patient key from `patients`	`MRN-4471903`
`choice`	Yes	`opt-in`, `withdraw`	`opt-in`
`scope`	If `opt-in`	`all`, `non-sensitive` (everything except what state or federal law treats as sensitive)	`all`
`captured_at`	Yes	datetime the decision was made	`2026-11-03T14:22:00-05:00`
`effective_start`	If `opt-in`	date the consent takes effect	`2026-11-03`
`effective_end`	If `opt-in`	date the consent expires, set by your policy; the record cannot be built without it	`2027-12-31`
`signer_type`	Yes	`member`, `personal-representative`	`member`
`signer_related_person_id`	If `personal-representative`	key from `related_persons`	`RP-88012`
`authority_document_id`	If `personal-representative`	key from `documents`	`DOC-55190`
`signed_form_document_id`	If `opt-in`	key from `documents`	`DOC-55192`
`last_updated`	Yes	datetime this row last changed in your system	`2026-11-03T14:22:00-05:00`
`is_deleted`	If retracting	`true` retracts a row delivered in error; a withdrawal is a `withdraw` row

An opt-in becomes an HRex Consent with provision.type = permit, provision.period from effective_start and effective_end, sourceReference to the signed form, and policy.uri from scope: all maps to #sensitive, non-sensitive to #regular. The names are the profile's: #sensitive is the wider grant. Both required actors are populated for each exchange: the previous or concurrent payer's Organization is source, and your Organization is recipient; provision.action is disclose. A withdraw row closes the election from captured_at.

previous_coverages

One row per previous or concurrent coverage the member names when opting in.

Column	Required	Format / values	Example
`record_id`	Yes	your identifier for this entry	`PCV-000342-1`
`consent_record_id`	Yes	`record_id` of the `opt-in` row it was named on	`P2P-000342`
`patient_identifier`	Yes	patient key from `patients`	`MRN-4471903`
`payer_name`	Yes	as the member gives it, ideally as printed on the member ID card	`Anthem Blue Cross`
`payer_id`	If known	the payer's identifier in the payer directory you use	`00060`
`member_id`	Yes	the member's ID with that payer; required to build the HRex Coverage used for member match	`XYZ123456789`
`relationship`	Yes	`self`, `spouse`, `child`, `other`; whether the coverage was in the member's own name subscriber-relationship	`self`
`coverage_kind`	Yes	`previous`, `concurrent`	`previous`
`last_updated`	Yes	datetime this row last changed in your system	`2026-11-03T14:22:00-05:00`
`is_deleted`	If retracting	`true` retracts this row

relationship is required by HRex Coverage and only the member can supply it. member_id becomes both subscriberId and the MB identifier. No coverage dates: the match runs on demographics and identifiers.

These resources are read by Provider Access and Payer-to-Payer.