Your Data Health
Technical Audit Protocol · TAP Composite Scorecard
Sample payer endpoint · 4 frameworks · illustrative
Target
Illustrative payer FHIR R4 endpoint audited across the four payer-relevant frameworks TAP scores today: HTI-1 Clinical EHR, Da Vinci PDex Plan-Net (provider directory), Da Vinci PDex Drug Formulary, and CMS-9115 Payer Patient Access. The composite weights each framework by regulatory penalty exposure. This sample mirrors the shape of a real payer engagement and matches the 82 / 100 composite shown on the TAP one-pager.
82
WARN
Payer FHIR composite audit (sample)
4 frameworks · weighted composite
WARN
Composite Score
82 / 100
Endpoint Type
payer
Frameworks
4
Passing
3
Failing
1
Framework Breakdown
HTI-1 Clinical EHR
Da Vinci PDex Plan-Net
Da Vinci PDex Drug Formulary
Payer Patient Access (CMS-9115)
Passing Requirements (sample, top 12 of 41)
| Req ID | Severity | Description | Regulatory Ref |
|---|---|---|---|
| HTI1-CAP-01 | Critical | Capability statement accessible | 45 CFR 170.315(g)(10) |
| HTI1-CAP-02 | High | FHIR version is R4 | 45 CFR 170.215(a)(1) |
| HTI1-IB-01 | High | Metadata reachable without auth within 10s | 45 CFR 171.301 (Information Blocking) |
| PDEX-PN-RES-01 | High | Practitioner resource supported with NPI identifier slice | PDex Plan-Net IG §Practitioner |
| PDEX-PN-RES-02 | High | PractitionerRole resource supported with network reference | PDex Plan-Net IG §PractitionerRole |
| PDEX-PN-RES-03 | Medium | Organization resource supported with payer network type | PDex Plan-Net IG §Organization |
| PDEX-PN-RES-04 | Medium | Location resource supported with accessibility slice | PDex Plan-Net IG §Location |
| PDEX-DF-RES-01 | High | FormularyDrug List resource supported | PDex Drug Formulary IG §FormularyDrug |
| PDEX-DF-RES-02 | Medium | Coverage Plan resource supported | PDex Drug Formulary IG §CoveragePlan |
| CMS9115-RES-01 | Critical | Patient resource supported (Patient Access API) | 45 CFR 422.119(b)(1) |
| CMS9115-RES-02 | High | ExplanationOfBenefit resource supported | 45 CFR 422.119(b)(1)(ii) |
| CMS9115-RES-03 | Low | USCDI v4 / US Core 7.x readiness (forward-looking) | 45 CFR 170.213 (USCDI v4) |
Failing & Gap Findings · Remediation
| Req ID | Severity | Description | Regulatory Ref |
|---|---|---|---|
| CMS9115-AUTH-01 | Critical | SMART on FHIR authorization for member-facing Patient Access not advertised
Deploy a SMART on FHIR authorization server and expose /.well-known/smart-configuration with authorization_endpoint and token_endpoint populated. Scopes must include patient/*.read, launch/patient, openid, fhirUser. Patient Access API non-conformance carries CMS enforcement exposure of up to $1M per API per day.
|
45 CFR 422.119(c)(1) |
| CMS9115-IB-01 | High | Bulk export ($export) not supported for member-claims history
Enable FHIR Bulk Data Access (Flat FHIR) $export on the Patient Access base. ExplanationOfBenefit, Coverage, and Patient resources must be exportable as NDJSON for downstream payer-to-payer flows under CMS-9115.
|
45 CFR 422.119(f) · Bulk Data |
| PDEX-PN-CAP-01 | Medium | CapabilityStatement.instantiates does not advertise Plan-Net IG
Add to CapabilityStatement.instantiates:
http://hl7.org/fhir/us/davinci-pdex-plan-net/CapabilityStatement/plannet-server. Config-only change, ~4 hours. TAP re-scan included in the Corrective Action plan. Projected score after fix: 95 / 100 composite. |
Da Vinci PDex Plan-Net IG |
| PDEX-DF-CAP-01 | Medium | CapabilityStatement.instantiates does not advertise Drug Formulary IG
Add to CapabilityStatement.instantiates:
http://hl7.org/fhir/us/davinci-drug-formulary/CapabilityStatement/usdf-server. Pairs with the Plan-Net fix. Both gaps close in one config push. |
Da Vinci PDex Drug Formulary IG |