Interoperability Patient Access API Financial v1

Summary API Attachments FAQ CHANGE LOG     

Overview

As part of the CMS Interoperability and Patient Access final rule (CMS-9115-F), members must have access to their financial data, including encounters and adjudicated claims. These APIs are required to retrieve that information on behalf of a member.

The Explanation Of Benefit FHIR resource provides all the financial CPCDS fields according to the CARIN implementation guide.

Prior to calling this, you must have the proper authentication tokens. Also, the Who Am I API is necessary to first understand logged-in users and their relationship to a dependent's information retrieved by this API.

More details on this API can be found in the Capability Statement API, as well as in the swagger document.

APIs in this category follow the FHIR Specifications v4.0.1: R4 found at http://hl7.org/fhir/resourcelist.html.

Prior to calling the Who Am I API, you must have the proper member authentication token. More information is available at: https://developers.changehealthcare.com/api/Security-and-Authorization/v2#.

Getting Started

See the Security section on this portal to learn more about securely using our APIs. Most of our APIs are private and require credentials to gain access.

Explanation Of Benefit

The Explanation Of Benefit (EOB) resource combines key information from a Claim, a ClaimResponse and optional Account information to inform a patient of the goods and services rendered by a provider and the settlement made under the patient's coverage in respect of that Claim.
The Explanation Of Benefit resource may also be used as a resource for data exchange for bulk data analysis, as the resource encompasses Claim, ClaimResponse and Coverage/Eligibility information.

Based on:

https://build.fhir.org/ig/HL7/carin-bb/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html

Change Log

API Name API Version Date Introduced Available Until
Interoperability Patient Access API Financial v1 12/28/2020 Current

Release Notes:

v1

  • Initial release.