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Interoperability Provider Access API

The Provider Access Application Programming Interface (API) allows you to securely request and receive electronic data about your patients who are covered by one of our plans1,2.
This data offers in-network providers a more complete picture of your patients' health to help you better coordinate their care and reduce administrative tasks.

Through the API, you’ll be able to access:

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How to connect and access data

To get started, your Information Technology team will need to connect your electronic health record (EHR) or electronic medical record (EMR) systems to our API. Once connected, providers can electronically request and receive patient data directly.
Share this Developer Portal with them for technical specifications and implementation guides:

Patient attribution

We verify treatment relationships to safeguard member privacy. Health information is shared only with the in-network providers who are actively involved in the member’s care. We verify this treatment relationship if:

  • We have received a dental, medical, pharmacy, or vision claim (EyeMed) for the member with your NPI (or your organization’s NPI) in the last 60 days (from the date of the request).
  • The member allows data-sharing (has not opted out)

Members will be listed as “inactive” if there are no qualifying claims within the previous 60 days.

Member control and privacy

Members can opt out of Provider Access API data sharing at any time. They can manage their preferences online or by calling Member Service at the number listed on their ID card.

Learn more by going to MyBlue.

FAQs
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Do patients have a say in sharing their data?

Yes. While the API helps improve care coordination, members maintain control over their health information. They have the right to opt out from us sharing data with their providers at any time.

How do I connect my electronic (EHR) or application to the API?

You will need an application compatible with our secure API endpoints. Refer to our Developer Portal and share with your IT teams or software vendors.

Resources
  1. Complies with the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F), a federal mandate designed to improve the secure electronic exchange of health information between payers, providers, and patients to streamline care coordination.
  2. The Provider Access APIs provide information about Blue Cross Blue Shield of Massachusetts commercial and Medicare Advantage members. Does not apply to Federal Employee Program members.