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API

Interoperability Patient Access - Financial

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.

Resources

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.

Knowgedge

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.

Developer Resources

Interoperability Patient Access - Financial

API Documentation
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