This is the STU3 (v1) documentation for the Blue Button API. STU3 is only intended for applications who began development prior to July 01, 2021.
Please consider utilizing the FHIR R4 (v2) implementation of the Blue Button API.
Overview
The Centers for Medicare and Medicaid Services (CMS) Blue Button 2.0 API enables Medicare beneficiaries to connect their Medicare claims data to the applications, services, and research programs they trust.
The CMS Blue Button 2.0 API:
- Enables a developer to register a beneficiary-facing application
- Enables a beneficiary to grant an application access to four years of their Part A, B, and D claims data
- Uses the HL7 FHIR standard for beneficiary data and the OAuth 2.0 standard for beneficiary authorization
Try the API
To join the Developer Sandbox, register a sample application and retrieve synthetic data for a sample Patient ID by calling the API, follow these four steps:
Step 1: Join the Developer Sandbox and register a sample application
Click “Add an Application” to register a new sample application and get a Client ID and Secret
Step 2: Generate a sample token
To test out the Blue Button API, you must first generate a sample token that represents a beneficiary granting consent.
To see a sample of Blue Button data you can access the Test Client.
- If you are already logged in to the Developer portal, log out
- In the navigation bar on https://sandbox.bluebutton.cms.gov click on “Test Client”
- Click “sample Authorization flow”
- Click the Authorization Link to authorize
-
You will be redirected to your Medicare account. Login with one of the synthetic beneficiary accounts
- Click “Allow” to Authorize sharing
- Review the details returned from the Authorization flow
- Make some API calls for the beneficiary account you used to authorize access
Step 3: Call the API
Try this out in Postman:
- From the Postman app, open a new tab
- Paste the Request URL:
https://sandbox.bluebutton.cms.gov/v1/fhir/Patient/-20140000008325 - Click “Authorization” and select type “OAuth 2.0”
- Click on “Get New Access Token”
-
Enter the following parameters:
Token Name: {The name of your app}
Grant Type: Authorization Code (unless you have chosen an alternate value for your app)
Callback URL: One of the redirect uris you registered for your app, for example:
http://localhost:3000Auth URL:
https://sandbox.bluebutton.cms.gov/v1/o/authorize/Access Token URL:
https://sandbox.bluebutton.cms.gov/v1/o/token/Client ID: {The Client ID assigned to your App in the sandbox}
Client Secret: {The Client Secret assigned to your App in the sandbox}
Scope:
patient/Patient.read patient/Coverage.read patient/ExplanationOfBenefit.read profileNOTE: When a beneficiary is authorizing your application, they will have the ability to omit the
patient/Patient.readscope. Be sure that you build your application accordingly to handle a 403 error if a beneficiary decides to filter their demographic information.State: An optional value that you may use in your app
Client Authentication: Select “Send as Basic Auth header”
-
Click Request Token. You should see a pop up for your Medicare account. Login using one of the synthetic beneficiary accounts
- Authorize sharing by clicking “Allow” on the authorization screen
- When you return to the Postman workspace you should now be able to make requests to the API using the Bearer Token that will have been placed in the Header
- Click “Send” and see the synthetic beneficiary’s personal health information as a Patient FHIR Resource display under “Body” in Postman
Once you have the Bearer Token you can also use Curl to make queries as follows:
curl --header "Authorization: Bearer YOUR TOKEN HERE" https://sandbox.bluebutton.cms.gov/v1/fhir/Patient/-20140000008325
Step 4: View the API Response
In the API response for Patient -20140000008325 you will find:
- 32 total claims (140 total claim lines)
- 25 carrier claims (110 carrier claim lines)
- 2 inpatient claims (25 inpatient claim lines)
- 5 Part D events
Step 5: Accessing Synthetic Data In order to access the full synthetic dataset for an individual synthetic beneficiary, you can do the following:
- Set up your sandbox application
- Log out of https://sandbox.bluebutton.cms.gov.
-
Access the authorization url at https://sandbox.bluebutton.cms.gov/v1/o/authorize/
Note: The last backslash is important. Also remember to append ?client_id={your client_id assigned to the application you registered}
- You will be redirected to the Medicare authentication screen on. DO NOT ACCESS THIS PAGE DIRECTLY.
-
Use one of thirty thousand provided usernames and passwords.
-
Approve access for your application, which will now receive an access token, which can be used in the requests described above.
- The authorization completes when you are redirected back to the Redirect_URI you specified when you registered your application.
Authorization
To use the Blue Button 2.0 OAuth 2 a developer must register their application.
A registered application is given a client ID and a client secret. The secret should only be used if it can be kept confidential, such as communication between your server and the Blue Button 2.0 API. Otherwise the Client Application Flow may be used.
Scopes
Access tokens have a scope, which defines what the access token can do and what resources it can access. For our purposes, scopes are primarily utilized to give Medicare beneficiaries more granular choice over what data they would like to share with applications. The Blue Button 2.0 API has implemented HL7 FHIR Scopes to manage access to beneficiary data. They look like this:
patient/Patient.read
patient/Coverage.read
patient/ExplanationOfBenefit.read
From the OpenID Connect specification we support:
profile
This gives access to the /v1/connect/UserInfo Endpoint.
Our OAuth screen gives beneficiaries the ability to choose whether or not to share their demographic information. Your application will need to handle the return of a 403 status code from the /v1/fhir/Patient and /v1/connect/userinfo endpoints.
If the beneficiary declines to share information that your application needs to function, you may display a message explaining why that information is needed and request reauthorization, or handle the collection of that information elsewhere within your application.
The default selection when a beneficiary reaches the authorization screen will be to share all data, including demographic data, with your application. If a beneficiary makes a selection as to whether or not they want to share demographic data with your application and later decides they want to change that selection, they’ll need to be taken through the authorization flow again to make a different choice from the OAuth screen.
Ensuring you still get the data you need
Take the time to ensure that you have fallbacks in place if you are unable to access the patient or userinfo endpoints.
For example, if you are getting the patient_ID from the v1/fhir/Patient endpoint, we recommend getting that identifier from the initial authorization response, or another resource like ExplanationOfBenefit or Coverage.
Explanation of needed data to Medicare Beneficiaries
If information limited by a scope is required for your application to properly function and it is not possible to get the information in another endpoint, we recommend providing an explanation about why certain data is needed in your user flow.
For example, if you use demographic information to help beneficiaries autofill tedious data-entry, you might want to explain that benefit before they reach the authorization screen. It is essential, however, that you give beneficiaries the full picture. If they do share that data with you for one-time data entry, they should know how long you keep it and if it is used for any other purposes.
What if my application doesn’t need demographic information from beneficiaries?
As stewards of sensitive data, it is important to adopt the practice of only asking for the data that is needed to perform a service for a beneficiary. As you register or edit an application in our Sandbox, you will see an option to choose whether or not your application needs to collect demographic information from beneficiaries.
If you choose not to collect demographic information, Medicare beneficiaries will see a simplified version of the OAuth screen as they no longer need to choose whether or not they want to share that information.
Native Mobile App Support
Native Mobile App Support follows the RFC 8252 - OAuth 2.0 for Native Apps authentication flow utilizing the PKCE extension and enables a custom URI scheme redirect.
The implementation of the RFC 8252 specification enables developers to build mobile applications without requiring a proxy server to route redirect calls to their mobile app.
The PKCE extension provides a technique for public clients to mitigate the threat of a “man-in-the-middle” attack. This involves creating a secret that is used when exchanging the authorization code to obtain an access token.
PKCE uses a code challenge that is derived from a code-verifier. The standard supports two styles of code challenge:
- plain
- S256
However, the Blue Button 2.0 API only supports the “S256” style code challenge.
Where the:
codechallenge = BASE64URL-ENCODE(SHA256(ASCII(codeverifier)))
The following additional parameters and values are sent as part of the OAuth2.0 Authorization Request:
code_challengecodechallengemethod = “S256”
More details can be found about this flow on OAuth.com. Check out this link: Protecting Mobile Apps with PKCE - OAuth 2.0 Servers
Registering Your App for Mobile App Support
When you register your application in the Blue Button 2.0 API Developer Sandbox, you will want to specify a unique custom URI scheme. This should be a unique value that will not conflict with other custom URI schemes implemented on a user’s mobile device.
We recommend that you define your custom URI scheme using a reverse domain name notation. As we developed our own testing application, we implemented a custom URI scheme of:
gov.cms.bluebutton.oauthtester
This equated to an oauthtester subdomain for the bluebutton.cms.gov domain.
The reverse DNS style custom URI scheme should then be coupled with the re-direct path on the mobile device that will handle the call back from the Blue Button 2.0 API.
For example:
tld.app.subdomain[.subsubdomain]:/callback/path/endpoint
A coding example of an OAuth 2.0 and PKCE flow is available here: Authorization Code with PKCE Flow - OAuth 2.0 Playground
The Blue Button 2.0 API engineering team has also created a sample Android application. You can review or fork the code here: https://github.com/CMSgov/bluebutton-sample-client-android
Redirect_URI
When creating an Application in the sandbox a redirect URI is required. This is the API endpoint on your system that receives the callback from the Blue Button 2.0 API after a beneficiary is passed to the Blue Button 2.0 API to authorize your application.
Multiple redirect URIs can be entered in the Redirect_URI field. Each entry should be separated by a space or newline.
A Redirect_URI follows this format:
URLprotocol://[sub-domain.]domain_name[:port]/path
URL Protocol
Three URL protocols are supported, depending on the purpose:
http:// protocolhttps:// protocolcustom_url:// protocol
http:// protocol
(Works in: Sandbox only)
The http:// format is only accepted in the sandbox environment. It is typically used by developers for local testing by using http://localhost/ however, any domain name can be used.
https://protocol
| (Works in: Sandbox | Production) |
The https:// format is used for secure communication and is required for all applications in the production environment unless the application is using the Mobile OAuth method for handling callbacks.
custom_url:// protocol
| (Works in: Sandbox | Production) |
The custom_url protocol is used by mobile applications to handle communications directly with your application on a mobile device.
If you are using Mobile OAuth support for communication directly with a mobile device the custom_url should follow this format:
Top-level.domain(TLD).domain-name[.sub-domain][.app_name]
For example, if the Blue Button 2.0 API team created an application we might create a custom_url of:
gov.cms.bluebutton.oauthtester
This would then be incorporated into a redirect URI entry. Here is an example:
gov.cms.bluebutton.oauthtester:8080//bluebutton_app/callback.html
Web Application Flow
To use this flow your application should be registered with Client Type set to confidential and
Grant Type set to authorization-code.
Request authorization from user
To allow a user to authorize your application, direct them to the Blue Button 2.0 API authorize endpoint.
The request must include the response_type set to code, your application’s client_id, and your application’s redirect_uri. An optional state field that your application can use to identify the authorization request is recommended.
https://sandbox.bluebutton.cms.gov/v1/o/authorize/?client_id=swBu7LWsCnIRfu530qnfPw1y5vMmER3lAM2L6rq2
&redirect_uri=http://localhost:8080/testclient/callback
&response_type=code
&state=8e896a59f0744a8e93bf2f1f13230be5
Exchange code for token
After visiting the authorization page
a user will be redirected back to
the redirect_uri
registered with
your application.
For example if
the redirect_uri
is http://localhost:8080/testclient/callback
BlueButton will redirect with this request.
GET http://localhost:8080/testclient/callback?code=TSjqiZCdJwGyytGjz2GzziPfHTJ6z2
&state=8e896a59f0744a8e93bf2f1f13230be5
Your application can now
exchange the code
provided in the redirected request
for a full token. Send a POST
request to the BlueButton token
endpoint providing the code,
the application’s client_id,
client_secret,
and redirect_uri.
Your request
must also specify the grant_type
which should always be authorization_code
for this flow.
curl -X POST "https://sandbox.bluebutton.cms.gov/v1/o/token/" \
-u "swBu7LWsCnIRfu530qnfPw1y5vMmER3lAM2L6rq2:<client_secret>" \
-d "code=TSjqiZCdJwGyytGjz2GzziPfHTJ6z2
&grant_type=authorization_code
&redirect_uri=http://localhost/testclient/callback"
Response
{
"access_token": "oQlduHNr09GKCU506GOgp8OarrAy2q",
"expires_in": 16768.523842,
"token_type": "Bearer",
"scope": "profile patient/Patient.read patient/ExplanationOfBenefit.read patient/Coverage.read"
"refresh_token": "wDimPGoA8vwXP51kie71vpsy9l17HN"
}
Client Application Flow
To use this flow
your application should
be registered with
Client Type set to public
and
Grant Type set to implicit.
Request authorization from user
To use the client application flow
direct the user to
the Blue Button 2.0 API authorization endpoint
with the response_type parameter set to token.
https://sandbox.bluebutton.cms.gov/v1/o/authorize/?client_id=swBu7LWsCnIRfu530qnfPw1y5vMmER3lAM2L6rq2
&redirect_uri=http://localhost:8080/testclient/callback
&response_type=token
&state=8e896a59f0744a8e93bf2f1f13230be5
If the user authorizes your application
they will be redirected back to
the redirect_uri of your application.
The request will include an access_token
in the fragment.
http://localhost:8080/testclient/callback#access_token=KCHMTX5VHNAXYGYv38eG2RLAX4hL6R
&expires_in=35849.875807
&token_type=Bearer
&scope=profile+patient%2FPatient.read+patient%2FExplanationOfBenefit.read+patient%2FCoverage.read
&state=8e896a59f0744a8e93bf2f1f13230be5
Below you will find a sample account you can use to test your Blue Button 2.0 API OAuth implementation. This account mimics a valid Medicare account but has reduced functionality. For example, you cannot test “Forgot Password” flow.
Jane Doe Username: BBUser29999 Password: PW29999!
Core Resources
Base Request URL:
https://sandbox.bluebutton.cms.gov
FHIR Resources:
- Explanation of Benefit
- Patient
- Coverage
UserInfo:
- Get User Profile from an Authorization Token
As a security measure the date of birth, SSN, and HICN will not be provided by the CMS Blue Button 2.0 API.
We use FHIR Extensions in our API responses.
Explanation of Benefit FHIR Resource
/v1/fhir/ExplanationOfBenefit/?patient=[fhir_id]
The above URL returns all of the beneficiary’s Explanation of Benefit (sometimes referred to as an episode of care)
records as an ExplanationOfBenefit FHIR Resource.
The bulk of a beneficiary’s data is contained within these ExplanationOfBenefit FHIR resources.
Each one can be thousands of lines long.
curl --header "Authorization: Bearer AUTHORIZATION TOKEN" "https://sandbox.bluebutton.cms.gov/v1/fhir/ExplanationOfBenefit/?patient=-20140000008325"
That API call will return an Explanation of Benefit that contains many FHIR resources and is typically thousands of lines long.
Learn more about the Explanation of Benefits FHIR resource in the Blue Button 2.0 API
{
"fullUrl": "https://sandbox.bluebutton.cms.gov/v1/fhir/ExplanationOfBenefit/carrier-22011027731",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "carrier-22011027731",
"contained": [
{
"resourceType": "ReferralRequest",
"id": "1",
"status": "completed",
"subject": {
"reference": "Patient/-20140000008325"
},
"requester": {
"agent": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "999999999999"
}
}
},
"recipient": [
{
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "999999999999"
}
}
]
}
]
...this is only a subset of the entire output...
Patient FHIR Resource
HTTP GET /v1/fhir/Patient/[fhir_id]The above URL returns the beneficiary’s demographics and other administrative information as a Patient FHIR Resource. This information is mostly contact information, not medical data.
curl --header "Authorization: Bearer AUTHORIZATION TOKEN" "https://sandbox.bluebutton.cms.gov/v1/fhir/Patient/-20140000008325"
{
"resourceType": "Patient",
"id": "-20140000008325",
"extension": [
{
"url": "https://bluebutton.cms.gov/resources/variables/race",
"valueCoding": {
"system": "https://bluebutton.cms.gov/resources/variables/race",
"code": "1",
"display": "White"
}
}
],
"identifier": [
{
"system": "http://bluebutton.cms.hhs.gov/identifier#bene_id",
"value": "-20140000008325"
},
{
"system": "http://bluebutton.cms.hhs.gov/identifier#hicnHash",
"value": "2025fbc612a884853f0c245e686780bf748e5652360ecd7430575491f4e018c5"
}
],
"name": [
{
"use": "usual",
"family": "Doe",
"given": [
"Jane",
"X"
]
}
],
"gender": "unknown",
"birthDate": "2014-06-01",
"address": [
{
"district": "999",
"state": "15",
"postalCode": "99999"
}
]
}
Download a sample Patient FHIR Resource
Coverage FHIR Resource
HTTP GET /v1/fhir/Coverage/?beneficiary=[fhir_id]
The above URL returns the beneficiary’s Coverage information as an Coverage FHIR Resource.
curl --header "Authorization: Bearer AUTHORIZATION TOKEN" "https://sandbox.bluebutton.cms.gov/v1/fhir/Coverage/?beneficiary=-20140000008325"
{
"fullUrl": "https://sandbox.bluebutton.cms.gov/v1/fhir/Coverage/part-a-20140000008325",
"resource": {
"resourceType": "Coverage",
"id": "part-a-20140000008325",
"extension": [
{
"url": "https://bluebutton.cms.gov/resources/variables/ms_cd",
"valueCoding": {
"system": "https://bluebutton.cms.gov/resources/variables/ms_cd",
"code": "10",
"display": "Aged without end-stage renal disease (ESRD)"
}
},
{
"url": "https://bluebutton.cms.gov/resources/variables/orec",
"valueCoding": {
"system": "https://bluebutton.cms.gov/resources/variables/orec",
"code": "0",
"display": "Old age and survivor’s insurance (OASI)"
}
},
{
"url": "https://bluebutton.cms.gov/resources/variables/esrd_ind",
"valueCoding": {
"system": "https://bluebutton.cms.gov/resources/variables/esrd_ind",
"code": "0",
"display": "the beneficiary does not have ESRD"
}
},
{
"url": "https://bluebutton.cms.gov/resources/variables/a_trm_cd",
"valueCoding": {
"system": "https://bluebutton.cms.gov/resources/variables/a_trm_cd",
"code": "0",
"display": "Not Terminated"
}
}
]
...this is only a subset of the entire output...
Compress Resources for more efficient data transfers
To improve the performance when transferring large data resources it is possible to turn on compression. Gzip compression is turned off by default. Compression can be activated for the following content types:
- text/html
- text/plain
- application/json
- application/fhir+json
To activate compression add the following to the header:
Accept-Encoding: gzip
The minimum payload size we will gzip is 1 kilobyte. If the original uncompressed size of the payload is less than 1 kb, we will not apply gzip compression to our response. Therefore, developers should ensure their applications handle this scenario gracefully by checking for the Content-Encoding: gzip response header before trying to decompress.
Download a sample Coverage FHIR Resource
Get User Profile for an Authorization Token
HTTP GET /connect/userinfo
The UserInfo Endpoint is an OAuth 2.0 Protected Resource.The above URL fetches the fictitious beneficiary’s basic account information given an Authorization Token. This is most often used when creating an account within your application. An HTTP GET is called and the response is returned as JSON.
curl --header "Authorization: Bearer AUTHORIZATION TOKEN" "https://sandbox.bluebutton.cms.gov/v1/connect/userinfo"
{
"sub": "fflinstone",
"prefered_username": "fflinstone",
"given_name": "Fred",
"family_name:, "Flinstone,
"name": "Fred Flinstone",
"email": "pebbles-daddy@example.com",
"created": "2017-11-28",
"patient": "123456789",
}
More Efficient Data Queries
Query by Type
Many developers are interested in specific claim types, such as PDE. The query by type feature will allow applications to request just those claims. This will enable applications to process and download data more quickly and efficiently.
ExplanationOfBenefit resources fall into 8 types:
CARRIERDMEHHAHOSPICEINPATIENTOUTPATIENTPDESNF
By default, the FHIR API returns all of these claim types when requesting the EOB for a beneficiary. You can use the Type query parameter to request specific claim types.
For example, to request only Part D drug claims, add the query parameter:
?type=pde
To request multiple claim types, a list of comma-separated values can be given for the TYPE parameter.
If multiple codes are specified, EOBs matching all of those claim types will be returned:
/v1/fhir/ExplanationOfBenefit?patient=123&type=carrier,dme,hha,hospice,inpatient,outpatient,snf
The full list of claim types are:
carrier
https://bluebutton.cms.gov/resources/codesystem/eob-type|carrier
pde
https://bluebutton.cms.gov/resources/codesystem/eob-type|pde
dme
https://bluebutton.cms.gov/resources/codesystem/eob-type|dme
hha
https://bluebutton.cms.gov/resources/codesystem/eob-type|hha
hospice
https://bluebutton.cms.gov/resources/codesystem/eob-type|hospice'
inpatient
https://bluebutton.cms.gov/resources/codesystem/eob-type|inpatient’
outpatient
https://bluebutton.cms.gov/resources/codesystem/eob-type|outpatient’
snf
https://bluebutton.cms.gov/resources/codesystem/eob-type|snf
It is important to use lower case when requesting a claim type. If you submit an invalid combination of claim types or use the wrong case you’ll see a message like this:
{
“detail”: “not a valid value”
}
The status code for this message is a 400 Bad Request.
Query by Type Examples:
In the sandbox there are synthetic beneficiaries with three of the eight claim types:
carrierinpatientpde
Let us take a synthetic beneficiary record:
Username: BBUser20023 and Password PW20023!
The FHIR ID for this beneficiary is -20140000000024
Let us do a regular ExplanationOfBenefit request:
https://sandbox.bluebutton.cms.gov/v1/fhir/ExplanationOfBenefit/
This bundle identifies 148 claims, returning the first 10. Here is how the start of the bundle will look:
{
“resourceType”: “Bundle”,
“id”: “9562c9b7-df79-419a-a94b-ef8cc9347e0e”,
“meta”: {
“lastUpdated”: “2019-11-05T22:05:48.257-05:00”
},
“type”: “searchset”,
“total”: 148,
“link”: [
{
“relation”: “first”,
“Url”: “https://sandbox.bluebutton.cms.gov/v1/fhir/ExplanationOfBenefit?_count=10&startIndex=0&patient=-20140000000024”
},
…
There are three claim types in this beneficiary’s record:
- Carrier (44)
- Inpatient (1)
- PDE (103)
The queries to request each claim type individually would be:
Carrier Claims
https://sandbox.bluebutton.cms.gov/v1/fhir/ExplanationOfBenefit/?type=carrier
Or
https://sandbox.bluebutton.cms.gov/v1/fhir/ExplanationOfBenefit/?type=https://bluebutton.cms.gov/resources/codesystem/eob-type|carrier
Inpatient Claims
https://sandbox.bluebutton.cms.gov/v1/fhir/ExplanationOfBenefit/?type=inpatient
Or
https://sandbox.bluebutton.cms.gov/v1/fhir/ExplanationOfBenefit/?type=https://bluebutton.cms.gov/resources/codesystem/eob-type|inpatient
PDE Claims Since many of our developers are interested in the Part D drug claims it is now possible to query for only PDE-type claims.
https://sandbox.bluebutton.cms.gov/v1/fhir/ExplanationOfBenefit/?type=pde
Or
https://sandbox.bluebutton.cms.gov/v1/fhir/ExplanationOfBenefit/?type=https://bluebutton.cms.gov/resources/codesystem/eob-type|pde
Query by “lastUpdated” Field
The HL7 FHIR specification provides a Meta section in each resource. The lastUpdated field represents the date and time of the last update. This takes the format of an “instant” type:
YYYY-MM-DDThh:mm:ss.sss+zz:zz.
The HL7 FHIR specification also provides a _lastUpdated query parameter for the search operations on the end-points. By using the _lastUpdated query parameter, an application will be able to request only the records that have changed before or after a specific date. If you keep track of the date of a previous request, you can request just the changes since your previous request. The format of this request would be:
https://sandbox.bluebutton.cms.gov/v1/fhir/Patient?_id=-19990000000001&_lastUpdated=gt2020-02-13T08:00:00-05:00&_format=application%2Fjson%2Bfhir’
The output from that request would look like this:
/v1/fhir/Patient?_id=-19990000000001&_lastUpdated=gt2020-02-13T08:00:00-05:00&_format=application%2Fjson%2Bfhir’
{
“resourceType”: “Bundle”,
“id”: “7d8ff6a1-95f9-4210-b08b-58a96ea74494”,
“meta”: {
“lastUpdated”: “2020-02-14T08:57:16.641-05:00”
},
“type”: “searchset”,
“total”: 1,
“link”: [
{
“relation”: “self”,
“url”: “https://prod-sbx.bfdcloud.net/v1/fhir/Patient?_format=application%2Fjson%2Bfhir&_id=-19990000000001&_lastUpdated=gt2020-02-13T08%3A00%3A00-05%3A00”
}
],
“entry”: [
{
“resource”: {
“resourceType”: “Patient”,
“id”: “-19990000000001”,
“meta”: {
“lastUpdated”: “2020-02-13T21:53:06.017-05:00”
},
“extension”: [
…
The BB2.0 API supports operators for less than (lt), greater than (gt), less than or equal (le), and greater than or equal (ge) the specified instant. It is also possible to specify a time interval by using two _lastUpdated parameters like this:
/v1/fhir/ExplanationOfBenefit?patient=Patient/-19990000000001&_lastUpdated=gt2020-02-13T08:00:00-05:00&_lastUpdated=lt2020-02-14T08:00:00-05:00&_format=application%2Fjson%2Bfhir
FHIR Data Model
We have mapped over 1,300 fields from the CMS claims data warehouse into FHIR. These fields are surfaced across the Patient, Coverage and Explanation of Benefits FHIR resources.
- Beneficiary Enrollment Record
- Carrier Claims
- Durable Medical Equipment
- Home Health Agency Claims
- Hospice Claims
- Inpatient Claims
- Outpatient Claims
- Part D Events
- Skilled Nursing Facility Claims
The Blue Button 2.0 API FHIR data model leverages coding systems specific to Medicare billing forms and/or the Chronic Conditions Warehouse, FHIR and Industry Coding Systems.
For Example:
View the full list of Blue Button 2.0 API FHIR Data Model Coding Systems and Identifiers
How Often Will New/Updated Data Be Available?
Medicare Part A, B, and D claims data will be refreshed weekly.
Our schedules may vary depending on many things like maintenance, delayed delivery of claims to the CCW data warehouse, or additional data quality processing that’s needed.
We recommend you have a daily job to fetch new claims data for your users. Please be responsible with your API usage and comply with the Service Management Rights to Limit conditions in the Blue Button 2.0 API Terms of Service.
Synthetic Data
The CMS Blue Button 2.0 API offers a synthetic data set for developers to test against. This means that each request returns a realistic value. For example, if a patient is prescribed the diabetes medication Metformin, the associated cost and date of this prescription will be accurate.
Please note that this synthetic data set does not represent a longitudinal patient view. The claims—though representative independently—are shuffled and randomly assigned to patients. To build the synthetic data set, we selected a number of random claims, and shuffling them like a deck of cards among a group of fictitious Patient IDs. This will allow developers to test the Blue Button 2.0 API system, but could result in a patient with records for contradictory procedures.
Production Data
The CMS Blue Button 2.0 API has at least one claim for over 53M beneficiaries.
Today, there are approximately 38M beneficiaries in traditional or fee-for-service Medicare. The Blue Button 2.0 API has Part A/B/D data for those beneficiaries plus Part D data for some beneficiaries on Medicare Advantage plans.
Part D has always been a separate program, but certain plans include both the MA benefits (Part C) and Part D. As a result, Part D drug event data is collected separately from MA encounter data. Part D drug event data for all participants in Part D has been collected by the agency since the program began in the mid-2000s.
The API also has historical claims data going back four years. All of these factors contribute to the 53M number we use to describe the total number of beneficiaries available via the Blue Button 2.0 API.
Sample Beneficiaries
CSV of 100 sample beneficiaries with rich claims data
When getting started with the Blue Button 2.0 API, it can be overwhelming to understand all of the coding systems and types of data that can be found in the Explanation of Benefit FHIR resource.
Below are some hypothetical Beneficiaries that gives you a sense of what is found in claims data.
Meet Lucille
Lucille is an 70-year old female. She has non-small cell lung cancer. Prior to her diagnosis, Lucille was active and had no significant health issues. She went on daily walks around her neighborhood, did yoga and made a concerted effort to eat healthy. Lucille smoked cigarettes for a few years when she was a teenager, but quit after her father passed away from lung cancer. Her only other family history is mild hypertension on her mother’s side.
Below are some examples you may find in the Explanation of Benefit FHIR resource for Lucille.
Office Visit
"service": {
"coding": [{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html",
"version": "0",
"code": "99215"
Lung Biopsy
"procedureCodeableConcept": {
"coding": [{
"system": "http://hl7.org/fhir/sid/icd-9-cm",
"code": "3328"
Diagnostic Radiology
"service": {
"coding": [{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html",
"version": "0",
"code": "70553"
Radiation Therapy
"service": {
"coding": [{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html",
"version": "9",
"code": "77263"
Chemo
"service": {
"coding": [{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.html",
"version": "0",
"code": "96400"
Meet Jack
“Jack” is a hypothetical 70 year-old male with Type 2 Diabetes and high blood pressure. Jack takes daily medication and his Doctor told him he needs to lose weight. He takes Glimepiride to help control his blood sugar and previously was on Metformin.
Production API Access
In order to gain production access, an organization should start by reviewing the Terms of Service and production access user guide. Once an organization believes it is fulfilling all the requirements detailed in the checklist and is adherent to the terms of service, they should email bluebuttonapi@cms.hhs.gov to set up a production access demonstration meeting with the CMS team.
Developer Guidelines
Below are guidelines you should follow to be successful in your Blue Button 2.0 API integration.
Your Privacy Policy
You will be asked to provide a URL to your privacy policy and terms and conditions when registering your app in the Blue Button 2.0 API Developer Portal. These links should be easy to access and understand by a beneficiary using your app. Consider using the Model Privacy Notice.
Rate Limiting and Data Refresh
Medicare Part A, B, and D claims data will be refreshed weekly.
Our schedules may vary depending on many things like maintenance, delayed delivery of claims to the CCW data warehouse, or additional data quality processing that’s needed.
We recommend you have a daily or weekly job to fetch new claims data for your users. Please be responsible with your API usage and comply with the Service Management Rights to Limit conditions in the Blue Button 2.0 API Terms of Service.
Use of the Blue Button 2.0 API Logo
The Blue Button 2.0 API logo and usage guidelines is detailed here.
Beneficiary Revokes Access
A beneficiary may revoke access to your application via the Medicare website. When you encounter an invalid token indicating a beneficiary has revoked access, you should make a reasonable attempt to handle that case making it easy for the beneficiary to understand what is happening with their Medicare data.
“Medicare is unable to retrieve your data at this time due to an internal issue. Our team is aware of the issue and is working to resolve it. Please try again at a later time. We apologize for any inconvenience.”
If you or your users encounters this error message, know that our team is aware of the issue and is working to resolve it as quickly as possible.
Blue Button 2.0 Implementation Guide
The Blue Button 2.0 API team has created a Blue Button 2.0 API Implementation Guide (BB2IG). You can access the guide here: Blue Button 2.0 API Implementation Guide.
The BB2IG features nine profiles in this version of the guide:
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