Member Attribution Resource Profiles

Using FHIR based APIs, providers and payers can exchange Member Attribution Lists (MAL) which can enable existing business processes and systems to meet various business needs. Opala uses FHIR profiles, search parameter definitions, and terminology artifacts to describe the content shared as part of Member Attribution List interactions.

Creating a MAL typically starts with a need to identify patients for a specific purpose, such as Risk Based Contracts or Quality Reporting. Once the patients are identified, other FHIR APIs and Da Vinci specifications can be used to retrieve clinical, financial, or other relevant information as required.

Resources

The following resources are available for the Opala Member Attribution (ATR) API:

• ATRCoverage. This resource enables the retrieval of specific coverage information.
• ATRGroup. This resource enables the review of changes to a group over time.
• ATRLocation. This resource associates a provider with a specific location.
• ATROrganization. This resource represents a payer, a settlement entity (when needed), or a provider organization.
• ATRPatient. This resource represents the patient/member profile.
• ATRPractioner. This resource represents the practitioner.
• ATRPractitionerRole. This resource represents the practitioner's role.
• ATRRelatedPerson. This resource represents the patient/member whose coverage is through someone they are related to.

For More Information

• Member Attribution List Data Model Requirements (4.2)