CMS Rule

Are there implementation guides payers can refer to when developing Patient Access APIs?

CMS has provided the following implementation guides (IGs) for the specific data elements required for the Patient Access and Provider Directory APIs. While use of these IGs is not required, it is highly recommended that payers leverage them when developing their APIs to avoid duplicative efforts. CMS has been working with HL7 and other industry partners to ensure these resources are freely available to payers.

Data Element

Implementation Guide

Claims and Encounters CARIN Blue Button Implementation Guide (FHIR IG)
Clinical Data (in USCDI v1) HL7 FHIR® US Core IG STU 3.1.0
Plan Coverage and Formularies
Da Vinci Payer Data Exchange US Drug Formulary IG
Provider Directory
Da Vinci PDEX Plan Net IG

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