CMS BlueButton API
Teams will have access to a number of APIs and data sources for the Code-a-thon. Teams may also use other public or private APIs.
The CMS BlueButton API is available at: https://api.bbonfhir.com
There are two data profiles available:
- Patient (i.e. Beneficiary)
- ExplanationOfBenefit (i.e. Claim)
In order to enable Code-a-thon teams to focus on creating data-driven apps we have created three versions of the Patient and ExplanationOfBenefit API calls:
- Login required:
https://api.bbonfhir.com/api/v1/Patient
https://api.bbonfhir.com/api/v1/ExplanationOfBenefit - OAuth 2.0 protected:
https://api.bbonfhir.com/api/v1/o/Patient
https://api.bbonfhir.com/api/v1/o/ExplanationOfBenefit - Login required but patient id can be supplied:
https://api.bbonfhir.com/api/v1/open/Patient
https://api.bbonfhir.com/api/v1/open/ExplanationOfBenefit
In the first version of the API calls if the Patient id or EOB id is supplied the value is overridden with the id that is linked to the logged in user.
In the second version the API overrides the Patient Id or EOB Id while using an OAuth2.0 protected call.
The third version is a custom API call for the code-a-thon. A Patient Id can be supplied and the appropriate Patient Profile or EOBs for a Patient Id will be returned.
See “Get My Data” page for a use case example.
Patient
API Calls:
-
https://api.bbonfhir.com/api/v1/Patient
-
https://api.bbonfhir.com/api/v1/Patient/{patient_id} -
https://api.bbonfhir.com/api/v1/o/Patient
-
https://api.bbonfhir.com/api/v1/o/Patient/{patient_id} -
https://api.bbonfhir.com/api/v1/open/Patient
-
https://api.bbonfhir.com/api/v1/open/Patient/{patient_id}
The Patient Profile typically has the following data:
- Identifier
- Name
- Address
- Date of Birth
The Patient Id (as used in the URL) is used to link ExplanationOfBenefit to a patient.
Default format
The default format is JSON.
XML can be requested.
To force a format add a URL parameter as follows:
- _format=json
- _format=xml
If a _format is not specified as an option the data is returned using json and displayed in an HTML layout.
example:
https://api.bbonfhir.com/api/v1/Patient/{patient_id}?_format=xml
Sample Patient Profile
{"resourceType": "Patient",
"id": "471476",
"meta": {"versionId": "1",
"lastUpdated": "2016-03-24T20:42:54.379-04:00"},
"identifier": [{"system": "CCW_BENE_CRNT_VW.BENE_ID",
"value": "1"}],
"name": [{"family": ["00016F745862898F"],
"given": ["f8"]}],
"birthDate": "1943-01-01",
"address": [{"line": ["688 SPRING ST NW, ATLANTA, GA", "303081934"]}]}
ExplanationOfBenefit
API Calls:
-
https://api.bbonfhir.com/api/v1/ExplanationOfBenefit
-
https://api.bbonfhir.com/api/v1/ExplanationOfBenefit?patient=Patient/{patient_id} -
https://api.bbonfhir.com/api/v1/o/ExplanationOfBenefit
-
https://api.bbonfhir.com/api/v1/o/ExplanationOfBenetit/
?patient=Patient/{patient_id} -
https://api.bbonfhir.com/api/v1/open/ExplanationOfBenefit
-
https://api.bbonfhir.com/api/v1/open/ExplanationOfBenetit/
?patient=Patient/{patient_id}
The ExplanationOfBenefit Profile typically has the following data:
Sample ExplanationOfBenefit Profile
{"resourceType": "ExplanationOfBenefit",
"id": "458790",
"extension": [{"url": "http://bluebutton.cms.hhs.gov/extensions#claimType", "valueCoding": {"system": "http://bluebutton.cms.hhs.gov/coding#claimType", "code": "FIXME2", "display": "Part B Carrier"}}],
"meta": {"versionId": "1",
"lastUpdated": "2016-03-24T11:18:31.095-04:00"},
"identifier": [{"system": "CCW_PTB_FACT.CARR_CLM_CNTL_NUM",
"value": "887673388711192"}],
"provider": {"reference": "Practitioner/458791"},
"diagnosis": [{"diagnosis": {"system": "http://hl7.org/fhir/sid/icd-9-cm/diagnosis", "code": "24981"}},
{"diagnosis": {"system": "http://hl7.org/fhir/sid/icd-9-cm/diagnosis", "code": "2724"}},
{"diagnosis": {"system": "http://hl7.org/fhir/sid/icd-9-cm/diagnosis", "code": "7295"}},
{"diagnosis": {"system": "http://hl7.org/fhir/sid/icd-9-cm/diagnosis", "code": "4439"}},
{"sequence": 4,
"diagnosis": {"system": "http://hl7.org/fhir/sid/icd-9-cm/diagnosis", "code": "53081"}},
{"sequence": 5,
"diagnosis": {"system": "http://hl7.org/fhir/sid/icd-9-cm/diagnosis", "code": "25070"}},
{"sequence": 6,
"diagnosis": {"system": "http://hl7.org/fhir/sid/icd-9-cm/diagnosis", "code": "V0481"}}],
"patient": {"reference": "Patient/458770"},
"coverage": {"coverage": {"reference": "Coverage/458773"}},
"item": [{"sequence": 1,
"diagnosisLinkId": [4],
"service": {"system": "HCPCS", "code": "11056"},
"servicedPeriod": {"start": "2009-12-21T00:00:00-05:00",
"end": "2009-12-21T00:00:00-05:00"},
"adjudication": [{"category": {"system": "CMS Adjudications",
"code": "Line Allowed Charge Amount"},
"amount": {"value": 90,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Part B Deductible Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Primary Payer Paid Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Coinsurance Amount"},
"amount": {"value": 20,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line NCH Payment Amount"},
"amount": {"value": 70,
"system": "urn:std:iso:4217",
"code": "USD"}}]},
{"sequence": 2,
"diagnosisLinkId": [5],
"servicedPeriod": {"start": "2009-12-21T00:00:00-05:00",
"end": "2009-12-21T00:00:00-05:00"},
"adjudication": [{"category": {"system": "CMS Adjudications",
"code": "Line Allowed Charge Amount"},
"amount": {"value": 10,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Part B Deductible Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Primary Payer Paid Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Coinsurance Amount"}, "amount": {"value": 20,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line NCH Payment Amount"},
"amount": {"value": 100,
"system": "urn:std:iso:4217",
"code": "USD"}}]},
{"sequence": 3,
"diagnosisLinkId": [5],
"servicedPeriod": {"start": "2009-12-21T00:00:00-05:00",
"end": "2009-12-21T00:00:00-05:00"},
"adjudication": [{"category": {"system": "CMS Adjudications",
"code": "Line Allowed Charge Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Part B Deductible Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Primary Payer Paid Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Coinsurance Amount"}, "amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line NCH Payment Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}}]},
{"sequence": 4,
"diagnosisLinkId": [5],
"service": {"system": "HCPCS", "code": "99000"},
"servicedPeriod": {"start": "2009-12-21T00:00:00-05:00",
"end": "2009-12-21T00:00:00-05:00"},
"adjudication": [{"category": {"system": "CMS Adjudications",
"code": "Line Allowed Charge Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Part B Deductible Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Primary Payer Paid Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Coinsurance Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line NCH Payment Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}}]},
{"sequence": 5,
"service": {"system": "HCPCS",
"code": "93784"},
"servicedPeriod": {"start": "2009-12-21T00:00:00-05:00",
"end": "2009-12-21T00:00:00-05:00"},
"adjudication": [{"category": {"system": "CMS Adjudications",
"code": "Line Allowed Charge Amount"},
"amount": {"value": 10,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Part B Deductible Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Primary Payer Paid Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Coinsurance Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line NCH Payment Amount"},
"amount": {"value": 10,
"system": "urn:std:iso:4217",
"code": "USD"}}]},
{"sequence": 6,
"diagnosisLinkId": [6],
"servicedPeriod": {"start": "2009-12-21T00:00:00-05:00",
"end": "2009-12-21T00:00:00-05:00"},
"adjudication": [{"category": {"system": "CMS Adjudications",
"code": "Line Allowed Charge Amount"},
"amount": {"value": 30,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Part B Deductible Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Beneficiary Primary Payer Paid Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line Coinsurance Amount"},
"amount": {"value": 0,
"system": "urn:std:iso:4217",
"code": "USD"}},
{"category": {"system": "CMS Adjudications",
"code": "Line NCH Payment Amount"},
"amount": {"value": 20,
"system": "urn:std:iso:4217",
"code": "USD"}}]}]},
"search": {"mode": "match"}
}