Payer Services Access APIs Specification
Service Overview
InterSystems Payer Services Access APIs support the sharing of patient health data and are designed in compliance with the CMS-0057-F regulationsOpens in a new tab. The APIs allow patients to access the health information held by their payer, providers to access clinical data for patients they have a relationship with, and payers to access health data for their members who have multiple or prior health plans. These APIs use a REST-based FHIR endpoint.
Refer to the Getting Started section for information on connectivity, authentication and how to get help. To use the REST APIs, you will need to know the base URL of the FHIR server you will be connecting to.
APIs and Use Cases
There are three APIs that share the same root endpoint, with the returned data filtered based on OAuth 2.0 scopes and the member’s consent settings for data sharing:
A patient uses their payer’s member portal to access their claims, encounter and cost information. They also have access to a defined subset of their clinical information.
Allows a payer to respond to queries from a member’s new payer with their patient data when the member has coverage with a new (or additional) payer.
Allows a provider to access information for a patient they have a treatment relationship with. This allows providers to coordinate a patient’s care, for example, when they have received services from out-of-network providers.
Standards
Payer Services Access APIs are designed in compliance with the specified versions of the following FHIR and Da Vinci Implementation Guides:
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CARIN Blue ButtonOpens in a new tab implementation guide version 1.0.0
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US CoreOpens in a new tab implementation guide version 3.1.1
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Payer Data ExchangeOpens in a new tab version 1.0.0.
Endpoints
URL
The root URL for the Access APIs is:
<BaseURL>/csp/healthshare/<namespace_identifier>/fhir/R4/
where <BaseURL>and <namespace_identifier> have been provided to you by the payer organization you are connecting with.
Add the required resource to the end of the URL for a specific endpoint, and include any necessary parameter values, as required. For example:
GET <BaseURL>/csp/healthshare/<namespace>/fhir/R4/Patient/10000001
Supported Resources
The Access APIs support the following resources:
Required Header Settings
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Content-Type: application/json+fhir
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Accept: application/json+fhir
Request Methods
Request methods should be called asynchronously as locating data from a FHIR repository may take an indeterminate amount of time to return a response.
Responses
The APIs use standard HTTP response status codes to indicate success or failure of the request. Data is returned in resources conforming to the standard specified in the supported resources table.
Errors will be returned in OperationOutcome resources, as defined by the FHIR standard. Errors will typically include additional explanatory text to help you troubleshoot any issues.