| Type |
Standard / Implementation Specification |
Standards Process Maturity |
Implementation Maturity |
Adoption Level |
Federally required |
Cost |
Test Tool Availability |
|
Implementation Specification
|
|
Final
|
Production
|
 |
Yes
|
$
|
Yes
|
|
Implementation Specification
|
|
Final
|
Production
|
 |
No
|
Free
|
Yes
|
|
Implementation Specification
|
|
Balloted Draft
|
Pilot
|
 |
Yes
|
Free
|
Yes
|
|
Implementation Specification
|
|
Balloted Draft
|
Pilot
|
 |
No
|
Free
|
Yes
Yes
|
= Federal FHIR Action Plan: Marks standards for coordinated federal adoption. See Appendix V: Federal FHIR Action Plan for more details.
| Federal FHIR Action Plan Alignment |
HL7 FHIR Consumer Directed Payer Data Exchange Implementation Guide (CARIN IG for Blue Button®) - This implementation specification provides a framework for payers to enable patient access to their claims information via a standardized FHIR API. It defines the Common Payer Consumer Data Set (CPCDS), which is a set of FHIR resources that payers can make available to patients. In addition to patient access, the profiles in this IG are expected to be reusable for other use cases, such as Provider Access and Payer-to-Payer APIs.
- CMS has identified CARIN IG for Blue Button Version 2.0.0 as ready for adoption in Certified Health IT. Developed by the CARIN Alliance, the IG is available for implementation without licensing requirements, making it accessible to payers and health IT developers.
- Implementers are encouraged to adopt the CARIN IG for Blue Button for use cases that require payers to provide patients with access to their claims information.
- Referenced in Federal Rulemaking: CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)
|
| Limitations, Dependencies, and Preconditions for Consideration |
Applicable Security Patterns for Consideration
|
- The Health Insurance Portability and Accountability Act (HIPAA) provides the regulatory foundation for electronic health care transactions. The ASC X12 837I transaction standard was adopted under HIPAA for institutional claims to increase efficiency and reduce paper use. More information is on the CMS website.
- ASETT serves as the HHS compliance tool for testing and complaint filing for X12 and NCPDP® transactions.
- The HL7 FHIR Consumer Directed Payer Data Exchange Implementation Guide (CARIN IG for Blue Button®) is recommended and adopted for HHS use to give patients API-based access to their claims and encounter data, including institutional claims. Its use is driven by two key federal rules:
|
- All covered entities and their business associates are required to comply with the HIPAA Privacy and Security Rules. Health and Human Services has partnered with the Office of the National Coordinator and the National Institutes of Standards and Technology to publish comprehensive guidance for Security specific to electronic protected health information. A self-assessment tool kit is available to support integrating privacy and security into practices.
|
Submitted by markaroberts85 on
CARIN Alliance Comments on ISA
The CARIN Alliance, a multi-sector group of stakeholders requests that ONC update the Health Care Claims or Equivalent Encounter Information for Professional Claims and Institutional Claims in the ISA to include the latest information related to the HL7® FHIR® Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) Implementation Guide (IG). Please see the attached comment letter for additional details.
CARIN Alliance Comments on ISA 093022.pdf