| 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
|
 |
Yes
|
Free
|
Yes
|
|
Implementation Specification
|
|
Balloted Draft
|
Pilot
|
 |
Yes
|
Free
|
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 Administrative Simplification provisions of HIPAA apply to the adoption of electronic transaction standards and operating rules for use in the health care industry. Information about the HIPAA regulations regarding standards and operating rules can be found at https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/index.html. Readers can find information about requirements for covered entities and their business associates and enforcement from this link.
- This standard and the transaction were adopted under the Health Insurance Portability Act of 1996 (HIPAA) to increase efficiency in the health care system by reducing the use of paper and increasing the exchange of health care information electronically. The current version was adopted in 2009 and required for use in 2012. Content from the transactions is often maintained in provider practice management and billing systems but duplicates information in electronic health records.
- Before implementation of a new version of a standard, end to end testing should be conducted with vendor systems and between trading partners to ensure changes have been accommodated.
- Additional information is available on testing, and the full cost on any of the X12 transactions. ASETT is the HHS compliance tool to enable testing and complaint filing for all X12 and NCPDP® transactions.
- Information about the CMS May 2020 Interoperability and Patient Access final rule and the implementation guides recommended to comply with the FHIR based APIs included in that rule may be found on the CMS Interoperability website. The HL7 FHIR Consumer Directed Payer Data Exchange (CARIN IG for BlueButton) STU 1 was recommended to comply with the Patient Access API requirement.
|
- 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_1.pdf