The Opala Member Attribution (ATR) API

Member attribution (ATR) is a method of identifying a patient-provider health care relationship—in other words, linking a patient to the provider responsible for their care. ATR is used to facilitate data exchange between patient, provider, and payor to support business use cases intended to streamline and improve health care delivery, and to improve data exchange with other payers.

ATR can be used for a variety of reasons, including:

• Reporting performance on specific targets and measures
• Identifying patients whom they can work with to improve performance for specific measures and targets
• Performing end of year reconciliation

ATR requests are asynchronous.

Note: When talking about ATR, the term "producer" generally refers to Opala and the term "consumer" generally refers to someone who accesses Opala's ATR API.

Member Attribution Lists (MAL)

Member Attribution Lists (MAL) can be used by, among others, providers and payers to implement use cases for Value-Based Contracts (VBC), Quality Reporting, Da Vinci Payer Data Exchange (PDex), and Da Vinci Clinical Data Exchange (CDex). Opala has initiated a method for using the Da Vinci FHIR ATR standard to exchange Member Attribution Lists. Attribution to VBC is included in the eligibility file.

Opala enables a user/consumer to:

1. Receive member attribution lists from a payer, in either a proprietary or standard format.
2. Make standards-based member attribution lists available using the FHIR API for access.

Member attribution lists inventory patients who are attributed to payers, providers, medical homes, or groups. Members may belong to multiple plans. The attribution list contains the member information along with additional information such as the attributed provider, health plan information, the validity period for the list, etc. A member may be present multiple times within a MAL; however, the combination of Member Identifier, Payer Identifier, Contract Identifier, and Plan Identifier is always unique and can be used to identify the member.

Data contained within the attribution list includes:

• Patient Demographics Data
• Attributed Provider Data (First Name, Last Name, ID, NPI, TIN, Address)
• Health Coverage Data (Subscriber ID, Member ID, Medicare ID, Medicaid ID, Plan Name, Plan Type, Enrollment Start and End Dates)
• Attribution Data (Effective Start and End Date for Attribution, Attribution Method)

Security

Opala uses SMART Backend Security to secure the API. SMART Backend Security describes the registration-time metadata required for a client to be pre-authorized, and the runtime process by which the client acquires an access token used to retrieve FHIR resources.

To view specific information about Opala's use of SMART Backend Security, see Opala's /.well-known/smart-configuration endpoint at:

https://api.opalahealth.io:45000/atr/v1/fhir/r4/.well-known/smart-configuration

This endpoint provides you with specific information about Opala's implementation of SMART Backend Security, including token_endpoint and scopes_supported

Documentation

The documentation for this API assumes that you are familiar with the HL7 FHIR Release 4 specification. If you are not, each resource topic in the documentation contains links to the referenced sections of the FHIR specification.

To access the public metadata for Opala's FHIR ATR API use:

https://api.opalahealth.io:45000/atr/v1/fhir/r4/metadata

You can also check the Additional Resources section of this topic for links with more information.

For More Information

• CapabilityStatement: DaVinci ATR Consumer
• Da Vinci - Member Attribution (ATR) List
• Da Vinci - Risk-Based Contracts Member Attribution List
• FHIR R4
• US Core STU3
• US Core Capability Statements
• Bulk Data IG
• SMART on FHIR Backend Services Authorization
• For information about Opala, see opala.com .
• To learn more about FHIR APIs, see the topics in the SMART on FHIR section in this documentation set, beginning with the SMART App Launch Framework topic.
• For information about Opala's ATR API resources, start with the Member Attribution (ATR) Resource Profiles topic in this documentation set.