Provider to Provider use case should be out of scope as it has not been tested.

To clarify, the Provider-Provider workflow is the same as Payor-Provider and the general use case of exchanging clinical data is also the same. The Direct Query approach is already being implemented through US Core and the Task based approach provides basic FHIR based transaction that requires human intervention. There is no federal agencies or other governing bodies requirement recommending adoption of CDex for Provider to provider exchange as far fas we know and testing is always encouraged. 1) update guide in background section to remove note to balloters  re provider to provider exchange and briefly describe the What Providers can do with clinical information. Point out that although this guide focuses on payor to provider, the technical exchange is not different if the data source is provider to provider. 2) update guidance and figure in Workflow Overview section to include provider as data consumer to make it clear 3) highlight the scenarios that are payor to provider and provider to provider 4) On Specification Page, add an informatory note that  When we say “Payer” on this page, we don’t mean to limit ourselves to only Payers. The same technology can be used for other data consumers like Providers.  Please read “Payer” here as a short-hand notation for "data consumer”