FAQ

You can visit CareFirst BlueCross BlueShield on https://www.carefirst.com/ website to find more information.

API stands for Application Programming Interface, which is a software intermediary that allows two applications to talk to each other. An API product bundles resources (such as API proxies) to provide a specific level of access and functionality for client app developers. On the other hand, an API product typically specifies a list of API proxies, along with access limits, API key approval method and other configurations that should be in place for all the bundled proxies.

On May 1, 2020, CMS published the CMS Interoperability and Patient Access final rule (CMS-9115-F) to establish policies that advance interoperability and patient access to health information. The rule required MA organizations, Medicaid managed care plans, CHIP managed care entities, and QHP issuers on the FFEs (collectively referred to as "impacted payers") to facilitate enhanced data sharing by exchanging data with other payers at the patient’s request. Please refer link Payer-to-Payer Data Exchanges on CMS website for more details.

Payer-to-Payer questionnaire document can be downloaded from this link.

Please send an email to DeveloperPortalSupport@carefirst.com with details about your concern.

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

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• 1. Patient Access API: The Patient Access API requires a Health Plan member to authorize access to their data. This API is inclusive of Carin BB and US Drug FHIR Implementation guides.
• 2. Provider Directory: This is a public facing API not requiring authorization from the member. This API implements Plan-Net FHIR guides.
• 3. Payer-to-Payer Data Exchange: Ability for health plans to share health information with another health plan to which the member transitions.

Please look into API Products and API documentation for more details.

Please register your application with the details requested as part of the application registration flow.

Developer attestation: This attestation (part of the CMS mandate) is separate from and not a part of CareFirst approval for API access. We encourage all developers who comply with the requirements of the Attestation to submit this during registration. Members requesting patient access for an application without the attestation will be shown a warning message to that effect.

CareFirst is taking a "Patient first" approach and supporting a growing number of HL7 FHIR Implementation Guides in addition to Non-FHIR APIs. You will be able to request access to FHIR Patient Access APIs for as well as network of contracted providers via the Provider Directory API for eligible CareFirst Plans and providers network using Provider API.

CareFirst provides a developer portal for developers to register. Please click the "Register" link on the top menu of this portal. You will need to provide your email address, phone and other details to register you as a developer during the registration process. Once your registration is complete, you can login as developer on the portal.

You will be able to view your application credentials, i.e., API Key and API Secret, once your application is approved via the developer portal. Please navigate to the list of your applications after login and click View Credentials.