CMS Blue Button 2.0 ExplanationOfBenefit API

openapi: 3.2.0
info:
  title: CMS Blue Button 2.0 Explanation Of Benefit API
  description: Blue Button 2.0 is the Centers for Medicare & Medicaid Services (CMS) patient-facing API that lets Medicare beneficiaries share their Parts A, B, and D claims data with applications they authorize.
  version: '2.0'
  contact:
    name: CMS Blue Button 2.0
    url: https://bluebutton.cms.gov
  termsOfService: https://bluebutton.cms.gov/terms/
servers:
- url: https://api.bluebutton.cms.gov/v2/fhir
  description: Production (approved applications only)
- url: https://sandbox.bluebutton.cms.gov/v2/fhir
  description: Sandbox (synthetic Medicare enrollee data, self-serve)
security:
- oauth2:
  - patient/ExplanationOfBenefit.read
  - patient/Patient.read
  - patient/Coverage.read
tags:
- name: ExplanationOfBenefit
  description: Medicare Parts A, B, and D claims as CARIN Blue Button EOB profiles.
paths:
  /ExplanationOfBenefit:
    get:
      operationId: searchExplanationOfBenefit
      tags:
      - ExplanationOfBenefit
      summary: Search a beneficiary's Medicare claims
      description: Returns the authorized beneficiary's Medicare Parts A, B, and D claims as ExplanationOfBenefit resources inside a FHIR Bundle, conforming to the CARIN Blue Button profiles.
      parameters:
      - name: patient
        in: query
        description: The FHIR logical id of the beneficiary Patient resource.
        schema:
          type: string
      - name: type
        in: query
        description: Claim type filter - one or more of carrier, pde, dme, hha, hospice, inpatient, outpatient, snf.
        schema:
          type: string
      - name: service-date
        in: query
        description: Filter claims by service date range using gt/lt/ge/le prefixes.
        schema:
          type: string
      - $ref: '#/components/parameters/lastUpdated'
      - name: excludeSAMHSA
        in: query
        description: When true, excludes claims related to substance abuse and mental health services (SAMHSA).
        schema:
          type: string
          enum:
          - 'true'
          - 'false'
      - name: includeTaxNumbers
        in: query
        description: When true, includes provider tax numbers in the response.
        schema:
          type: string
          enum:
          - 'true'
          - 'false'
      - $ref: '#/components/parameters/count'
      - $ref: '#/components/parameters/startIndex'
      responses:
        '200':
          description: A FHIR Bundle of ExplanationOfBenefit resources.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/Bundle'
        '401':
          $ref: '#/components/responses/Unauthorized'
  /ExplanationOfBenefit/{id}:
    get:
      operationId: readExplanationOfBenefit
      tags:
      - ExplanationOfBenefit
      summary: Read a single claim by id
      description: Returns a single ExplanationOfBenefit resource by FHIR logical id.
      parameters:
      - $ref: '#/components/parameters/resourceId'
      responses:
        '200':
          description: An ExplanationOfBenefit resource.
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/ExplanationOfBenefit'
        '401':
          $ref: '#/components/responses/Unauthorized'
        '404':
          $ref: '#/components/responses/NotFound'
components:
  responses:
    NotFound:
      description: No resource exists with the supplied id for this beneficiary.
    Unauthorized:
      description: Missing, expired, or invalid OAuth 2.0 access token.
  schemas:
    Bundle:
      type: object
      description: A FHIR R4 searchset Bundle wrapping matching resources.
      properties:
        resourceType:
          type: string
          enum:
          - Bundle
        type:
          type: string
        total:
          type: integer
        link:
          type: array
          items:
            type: object
            properties:
              relation:
                type: string
              url:
                type: string
        entry:
          type: array
          items:
            type: object
            properties:
              resource:
                type: object
    ExplanationOfBenefit:
      type: object
      description: FHIR R4 ExplanationOfBenefit conforming to the CARIN Blue Button profiles - one of carrier, pde (Part D drug event), dme, hha, hospice, inpatient, outpatient, or snf claim types.
      properties:
        resourceType:
          type: string
          enum:
          - ExplanationOfBenefit
        id:
          type: string
        type:
          type: object
        patient:
          type: object
        billablePeriod:
          type: object
        insurance:
          type: array
          items:
            type: object
        item:
          type: array
          items:
            type: object
        total:
          type: array
          items:
            type: object
  parameters:
    startIndex:
      name: startIndex
      in: query
      description: Zero-based index of the first record to return for pagination.
      schema:
        type: integer
    lastUpdated:
      name: _lastUpdated
      in: query
      description: Filter by the record's last_updated date using gt/lt prefixes; may be supplied more than once to define a range.
      schema:
        type: string
    count:
      name: _count
      in: query
      description: Number of records per page for pagination.
      schema:
        type: integer
    resourceId:
      name: id
      in: path
      required: true
      description: The FHIR logical id of the resource.
      schema:
        type: string
  securitySchemes:
    oauth2:
      type: oauth2
      description: OAuth 2.0 authorization-code flow with mandatory PKCE (S256 only). Beneficiaries log in with their Medicare.gov credentials and choose whether to share demographic data. Access tokens expire after 1 hour. One-time-use refresh tokens are issued only to approved 13-month and research application types. Sandbox uses https://sandbox.bluebutton.cms.gov/v2/o/authorize/ and https://sandbox.bluebutton.cms.gov/v2/o/token/.
      flows:
        authorizationCode:
          authorizationUrl: https://api.bluebutton.cms.gov/v2/o/authorize/
          tokenUrl: https://api.bluebutton.cms.gov/v2/o/token/
          refreshUrl: https://api.bluebutton.cms.gov/v2/o/token/
          scopes:
            patient/Patient.read: Read the beneficiary's Patient demographic resource.
            patient/ExplanationOfBenefit.read: Read the beneficiary's Medicare claims.
            patient/Coverage.read: Read the beneficiary's Medicare coverage.
            openid: OpenID Connect authentication.
            profile: Access the userinfo profile endpoint.
            launch/patient: Receive the patient FHIR id in the token response.