The HL7 Da Vinci Project is an industry accelerator that produces FHIR implementation guides for payer-provider workflows in value-based care. Its best-known IGs automate prior authorization and coverage: CRD (Coverage Requirements Discovery), DTR (Documentation Templates and Rules), and PAS (Prior Authorization Support), alongside PDex for payer data exchange and others. Da Vinci is how the administrative, money-and-coverage side of US healthcare is being pulled onto FHIR.
Da Vinci
Da Vinci is the effort to put the administrative half of healthcare — coverage, prior authorization, payer data — onto FHIR, where most FHIR energy has gone to clinical data. It is a set of implementation guides that automate the paperwork sitting between a clinician’s decision and getting paid for it.
- The prior-auth trio - CRD (does this need authorization?), DTR (fill in the required documentation from the record), and PAS (submit and track the request) turn a fax-and-phone process into an API workflow.
- PDex and payer exchange - Standardizes moving a member’s clinical and claims data between payers and to providers.
- Built on US Core - Every IG is FHIR profiles layered on the same base, so it composes with clinical interoperability rather than forking from it.
Da Vinci matters to my scoring because it is where the CMS Interoperability and Prior Authorization rule (CMS-0057-F) points — the regulation names these IGs as the way to do electronic prior authorization. And yet it is one of the emptiest frontiers I measure: a single provider in the US cohort (1upHealth) explicitly conforms. It is the clearest place where a mandate has named a good standard and the market has not yet shown up to build it.
Referenced in API Evangelist papers
This standard shows up in my published research. These reports read the machine-readable evidence provider by provider — and put this standard in the context of a real sector.
The State of US Healthcare APIs
1upHealth explicitly conforms to Da Vinci CRD/DTR/PAS; it is otherwise a near-empty frontier.
Governed by these regulations
A standard is the machine-readable contract; a regulation is the law that requires it. These are the regulations that mandate or drive this standard, catalogued at regulations.apievangelist.com.
CMS Interoperability & Prior Authorization Rule
CMS-0057-F points at Da Vinci PAS/DTR/CRD as the standard for electronic prior authorization.
