$member-match

HRex Member Match Operation

activeDa Vinci HRex1.2.0operation4 inputs2 outputs

The $member-match operation that can be invoked by either a payer or an EHR or other system, allows one health plan to retrieve a unique identifier for a member from another health plan using a member's demographic and coverage information. This identifier can then be used to perform subsequent queries and operations. Members implementing a deterministic match will require a match on member id or subscriber id at a minimum (i.e. A pure demographic match will not be supported by such implementations.).

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/us/davinci-hrex/OperationDefinition/member-match
Code
$member-match
Kind
operation
Affects State
Yes
Publisher
HL7 International / Clinical Interoperability Council

Invocation Context

Can be invoked at:
Type Level
Target Resources:
Affects State:Yes

Input Parameters (4)

NameTypeCard.Description
MemberPatient*Patient1..1Parameter submitted by the new plan **SHALL** contain US Core Patient containing member demographics.
ConsentConsent0..1Consent held by the system seeking the match that grants permission to access the patient information information on the system for whom a patient is sought. Downstream IGs could tighten this to 'required' if necessary.
CoverageToMatch*Coverage1..1Parameter that identifies the coverage to be matched by the receiving payer. It contains the coverage details of health plan coverage provided by the member, typically from their health plan coverage card.
CoverageToLinkCoverage0..1Parameter that identifies the coverage information of the member as they are known by the requesting payer. This information allows the matching payer to link their member coverage information to that of the requesting payer to ease subsequent exchanges, including evaluating authorization to share information in subsequent queries. This parameter is optional as this operation might be invoked by non-payer systems. However, it is considered 'mustSupport'. If the client invoking the operation is a payer, they **SHALL** include their coverage information for the member when invoking the operation.

Output Parameters (2)

NameTypeCard.Description
MemberIdentifierIdentifier1..1This is the member identifier information for the patient as known by the server that is the target of the operation.
MemberIdReference0..1This is the RESTful identity for the patient as known by the server that is the target of the operation.

Additional Information

Version
1.2.0
Date
2026-03-24T17:12:23+11:00