FAQ: Which Payers APIs are available? (onyxOS)

Q: Which Payers APIs are available as part of the CMS Interoperability and Patient Access Rule?

The CMS Rule requires regulated Health Plans to provide the following APIs:

• Patient Access API

  The Patient Access API requires a Health Plan member to authorize access to their data.

• Open API

  The Open Access API does not require a member, or the Health Plan’s authorization, to access the APIs.

The APIs that are included in each API category are those that fall into the following HL7 FHIR Implementation Guides:

• Patient Access API

  • CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
  • Da Vinci Payer Data Exchange which incorporates the HL7 FHIR® US Core Implementation Guide STU3 Release 3.1.1
  • DaVinci Payer Data Exchange (PDex) US Drug Formulary

• Open API

  • DaVinci PDEX Plan Net

  • Optionally, a Health Plan may choose to make the Da Vinci Drug Formulary APIs available as an Open API.

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