Member Consent (CSV)

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. Members can also record both choices themselves on the member portal's Data sharing page, which writes Consents of the same profiles. A system that already holds the decisions as FHIR writes the records itself instead: see Member Consent (FHIR).

Data conventions

provider_access_opt_outs

One row per decision on the Provider Access switch.

opt-out becomes provision.type = deny, share becomes permit. captured_at is Consent.dateTime, effective_start is provision.period.start. performer is the member's Patient; a personal-representative row adds the RelatedPerson as a provision.actor with the role of their authority (POWATT, GUARD or RESP). The rest of the profile is filled from plan configuration, not from the row: status active, scope patient-privacy, the two category codes (IDSCL, which PDex 2.1.0 requires, and the API purpose provider-access from the PDex 2.2.0 draft, which tells the two decisions apart: IDSCL alone does not), 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.

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. performer is the member's Patient, or the RelatedPerson for a personal-representative row. Both required actors are populated for each exchange: each plan named in previous_coverages is a source actor, and your Organization is recipient; provision.action is disclose; the categories are IDSCL and the API purpose payer-to-payer, as above. A withdraw row closes the election from captured_at: the opt-in's Consent is retired, status inactive without its profile.

previous_coverages

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

relationship is required by HRex Coverage and only the member can supply it. member_id becomes both subscriberId and the MB identifier. coverage_kind becomes status: cancelled for a previous plan, active for a concurrent one. The plan becomes payor: the Organization of a plan registered in Consent Settings when payer_id or payer_name identifies one, otherwise an HRex Organization named payer_name and numbered by record_id; the same Organization is the opt-in's source actor. No coverage dates: the match runs on demographics and identifiers. The member's Patient must declare the HRex Patient Demographics profile, which beneficiary requires.

consent_documents

One row per document behind a decision: the signed form, and the document of authority a personal representative acts under. The document itself is the file; this row is its index card.

• type_code has a required binding, so the type must come from that value set. Two codes cover the feed: 59284-0 for every signed form, 64298-3 for a power of attorney; 64299-1 for the other documents of authority.
• author is not a column: it comes from the decision row that names the document, the member's Patient for member and the RelatedPerson for personal-representative. A document named by several decisions, such as one power of attorney for both switches, is delivered once.
• Payerbox sets status to current, category to clinical-note (the profile requires a category, and that is the one code in the US Core category value set), custodian to your Organization and content.format to urn:ihe:iti:xds:2017:mimeTypeSufficient, and reads the attachment's content type and size from the stored file. None of those are columns.
• A decision points to its documents, so they must load first: deliver consent_documents in the same window as the decisions, before them or with them. An opt-in without its signed form is not built.

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