HL7 Da Vinci Project Implementation Guides

1. HRex (Health Record Exchange)

   Shared profiles and exchange patterns used by other Da Vinci IGs.

2. Coverage Requirements Discovery

   CDS Hooks used to tell clinicians about payer coverage and documentation rules.

3. Documentation Templates and Rules

   SMART apps and CQL to collect documentation for coverage requirements.

4. Prior Authorization Support

   Claim/$submit prior authorization requests and ClaimResponse decisions.

5. Payer Data Exchange

   Payer-to-payer exchange, member match and clinical data from payers.

6. Plan-Net directory

   Payer provider directory profiles and search.

7. Drug Formulary

   Formulary and coverage plan profiles including tiers and prior auth flags.

8. Clinical Data Exchange

   Payer requests for clinical documentation and attachments.

9. Member Attribution

   Attribution lists of members to providers using Group resources.

10. Risk Adjustment

    Risk adjustment coding gaps and HCC reporting.

Each section links to the official page. Titles and summaries by Extra Credit; the docs belong to their authors.

• CMS Interoperability and Patient Access Rules
• CMS-1500 Claim Form
• Da Vinci Payer Data Exchange (PDex)
• Da Vinci Prior Authorization Support (PAS)
• DICOM
• FHIR Bulk Data Access
• HL7 FHIR R4
• HL7 FHIR R5
• HL7 Version 2.x
• Medicare and Medicaid Claims Data (CMS data dictionaries)
• NCPDP SCRIPT
• NCPDP Telecommunication Standard