The Explanation Of Benefit resource provides details on claims submitted by a provider, as well as details on final payer adjudication of each claim.
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:
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.
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View our Change Log/Release Notes for more information on this API