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Interoperability Provider Directory Formulary

There are two formulary resources that conform to the HL7 FHIR standards. These resources provide information that together provide information on the formulary.

The two resources in this category can provide complete payer formulary information. Coverage iformation from the WhoAmI endpoint can retrieve details of a specific member's plan formulary.

Access

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.

Implementation

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

Authentication

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 Provider Directory API Formulary

API Documentation
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