Application Developers

There is no better time to be a third-party application developer who wants to provide more clinical and claims information to their consumers. Application Programming Interfaces (APIs) are providing more access to health care data than ever before. While not comprehensive, listed below are a number of resources you can use to learn more about how you can empower consumers with a copy of their health information.

Enabling policy and regulation

There are several policies that are enabling consumers access to their health information.

Clinical information
As part of the Quality Payment and Promoting Interoperability Program (QPP), the Centers for Medicare and Medicaid Services (CMS) issued a requirement to “Provide Patient Access” to their electronic health information.

Claims information
The Medicare Blue Button® 2.0 project provides developers the ability to access Medicare fee-for-service claims for 53 million Medicare beneficiaries.

The 2019 Medicare Call Letter discusses the CMS recommendation for plans to ‘meet or exceed the capabilities of Medicare Blue Button 2.0’. The CARIN Alliance has organized a group of health plans, third-party application providers, and others to define the data fields and format for what ‘meet or exceed’ means. You can learn more in the Health Plan workgroup section of our website.


Industry-led and standard development organizations (SDOs) efforts

Clinical information
Most of the electronic health record (EHR) vendors have developed an upgrade to their technology to accommodate for the “Provide Patient Access” requirement in the QPP by voluntarily following an industry-agreed upon approach for releasing their data via an Application Programming Interface (API). It’s called the Argonaut Project and more information can be found here.

Claims information
For claims and explanation of benefit (EOB) information that are electronically being sent to the consumer, you can learn more by You can learn more in the Health Plan workgroup section of our website.


Access to provider FHIR end points

Many consumer-facing applications struggle to access the client FHIR end points for each of the providers across the country. In the CMS Interoperability and Patient Access rule, CMS is requiring providers publish their FHIR end points in the NPPES files. For all consumer-facing applications, they can now access end point information via the new NPPES downloadable file mentioned on the CMS website below assuming the provider has included their end point with their other provider contact information.


Starting June 18, 2018, the zipped NPPES Downloadable file will also include the following 3 new reference files: 

  1. Other Name Reference File – this file contains additional Other Names associated with Type 2 NPIs
  2. Practice Location Reference File – this file contains all of the non-primary Practice Locations associated with Type 1 and Type 2 NPIs
  3. Endpoint Reference File –this file contains all Endpoints associated with Type 1 and Type 2 NPIs.