Operon coordinates $member-match and historical-data exchange between concurrent and prior payers, normalizing bundles across underlying systems.
Operon's Payer-to-Payer API capability surface vs Da Vinci PDex Payer-to-Payer IG latest published. Verified 2026-05-10.
| Resource | Profile | Read | Search | Write | Notes |
|---|---|---|---|---|---|
| Patient | US Core Patient | Yes | Yes | No | |
| Coverage | CARIN BB Coverage | Yes | Yes | No | |
| ExplanationOfBenefit | CARIN BB EOB | Yes | Yes | No | |
| Encounter | US Core Encounter | Yes | Yes | No | |
| Condition | US Core Condition | Yes | Yes | No | |
| MedicationRequest | US Core MedicationRequest | Yes | Yes | No | Used in $member-match and historical bundle |
Primary IG
Companion IGs
Authentication
OAuth 2.0 inside the payer-to-payer trust framework with mutual-TLS plus client-credentials flow.
Supported FHIR Operations
POST /Patient/$member-matchPOST /Group/$exportGET /Bundle/{id} Operon publishes a CapabilityStatement aligned to Da Vinci PDex Payer-to-Payer IG. The current version ships in the Operon CMS-0057-F Testing Spec; a hosted metadata endpoint follows in v2.
The exact paths your testing partners hit. Each scenario maps to a concrete request shape, expected response, conformance checkpoints, and the readiness metric Operon emits.
Scenario 1
POST $member-match with Patient + Coverage seedScenario 2
POST $member-match with insufficient demographicsScenario 3
GET historical bundle for matched memberScenario 4
Repeat historical bundle request with original correlation idWhat's Provisioned
Two prior-plan members with five-year historical coverage spanning multiple plans, designed to exercise both clean and ambiguous match paths.
Sample bundle excerpts are included in the Operon CMS-0057-F Testing Spec PDF. Full bundles are loaded into your sandbox tenant when your testing window is provisioned.
Step 1
Submit org type, role, this API selection, target window, and system-of-record context.
Step 2
Provisioned within 2 business days; 60-minute joint kickoff confirms scenarios, conformance targets, and success criteria.
Step 3
1 to 4 weeks of live testing with daily conformance and latency telemetry, ending in a public-reporting-ready conformance and readiness report.
End-of-Engagement Report
Per-scenario conformance vs Da Vinci PDex Payer-to-Payer IG, match precision/recall report, latency distribution, and idempotency verification.
Readiness Metrics Emitted
CARIN BB IG v2.0.0
Members access their claims, EOBs, encounters, and clinical data through authorized apps.
View Patient Access API Details →Da Vinci PDex Provider Access IG latest published
Providers under attribution agreement pull clinical, claims, and encounter data via group-based bulk export.
View Provider Access API Details →Da Vinci PAS IG latest published
Plans and providers submit, inquire, and act on PA decisions across UM vendors and internal review queues.
View Prior Authorization API Details →Da Vinci CRD IG v2.0.1 / v2.1.0 / v2.2.1 concurrent
Plans expose CDS Hooks services so a provider EHR can surface prior-authorization requirements at order entry or order-sign time, before the claim is submitted.
View Coverage Requirements Discovery (CRD) Details →Da Vinci DTR IG v2.0.1 / v2.1.0 / v2.2.0 concurrent (Standard + Adaptive)
Plans expose payer-defined Questionnaires (Standard and Adaptive) that the provider EHR can launch from a CRD card, pre-populate from clinical data, and attach to the subsequent PA Claim.
View Document Templates and Rules (DTR) Details →30 minutes with our team. We'll ask about the systems you already run, where you are on the CMS-0057-F calendar, and what testing you need to ship.