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Overview for Developers

Overall background on the CMS Interoperability and Patient Access Rule for your apps to access FHIR R4 Payer data
This July 2021 (and the months leading) 1upHealth will be supporting FHIR R4 data from 100s of Health Plans (Health Insurance Companies) like Aetna, Cigna, etc. This is a massive opportunity to build applications on Claims, Financial, and Clinical data that will become available for millions of new patient / member connections.

What you need to know.

  • Your apps will not work automatically with these health plans and FHIR R4 Data. You need to modify your apps to support FHIR R4 (revision 4) and new data types. Please scope out some time (budget 2 weeks - 1 month) to get your apps ready.
  • In order for your application to be visible to members at these health plans you will need to update your apps and demonstrate support for R4 as well as provide some additional application details (logo, description, etc.) if you have not already done so. See more information in Getting Started with CMS R4 APIs.
  • What technology is required to connect to 1up Payer Patient Access APIs?
    • OAuth 2.0 authorization_code flow where you will access a payer's /authorize endpoint with your client ID, redirect, and optionally state parameter and scope
    • Optionally can use OpenID Connect (OIDC) which is supported
    • FHIR R4 APIs
  • What version of FHIR does your FHIR server support?
    • Payer Patient Access endpoints are exclusively FHIR R4
  • What FHIR resources are supported for 1up Health Plans?
    • For some payers the only data available is claims and coverage (ExplanationOfBenefit, Patient, Coverage resources).
    • For others there are clinical FHIR resources available (e.g., Observation, CarePlan, DiagnosticReport resources)
  • What scopes are supported?
    • By default your application will be given patient/*.read scope to our endpoints enabling you to access all FHIR resources available for a given authenticated member
    • We support openid as a scope to receive an ID token in line with the OpenID Connect standard
This is massive news because adoption of R4 will create a true standard and another important step towards true FHIR interoperability. FHIR R4 builds on the already existing legacy of DSTU2 and STU3 which enables access to patient’s clinical data, all of which you can access via the 1upHealth FHIR API platform. Some of the CMS most common R4 resources that will further expand the amount of data you’re able to query include:
  • ExplanationOfBenefit
  • Coverage
  • Organization
  • Patient
  • Practitioner
  • Location

What does all of this mean?

FHIR R4 is considered to be even more stable where all of the future FHIR versions will begin to be backward compatible with the R4 components outlined above. This means you will now have more access to data, and dedicate more time to where it really matters; the patient.