CMS — Centers for Medicare & Medicaid Services

CMS — Centers for Medicare & Medicaid Services ExplanationOfBenefit API

The ExplanationOfBenefit API from CMS — Centers for Medicare & Medicaid Services — 2 operation(s) for explanationofbenefit.

Documentation GitHub OpenAPI

OpenAPI Specification

openapi: 3.0.3
info:
  title: CMS AB2D Articles ExplanationOfBenefit API
  description: 'AB2D delivers Medicare Parts A, B, and D claims data to Part D Prescription Drug Plan

    sponsors via the HL7 FHIR Bulk Data Access specification. Asynchronous $export returns

    ExplanationOfBenefit NDJSON for all enrolled Medicare beneficiaries since 2020.

    '
  version: '2.0'
  contact:
    name: AB2D Help
    url: https://ab2d.cms.gov/
    email: ab2d@cms.hhs.gov
  license:
    name: Public Domain (U.S. Government Work)
    url: https://www.usa.gov/government-works
servers:
- url: https://api.ab2d.cms.gov/api/v2
  description: Production
- url: https://sandbox.ab2d.cms.gov/api/v2
  description: Sandbox
security:
- BearerAuth: []
tags:
- name: ExplanationOfBenefit
paths:
  /ExplanationOfBenefit:
    get:
      summary: Search Explanation Of Benefit Resources
      operationId: searchExplanationOfBenefit
      tags:
      - ExplanationOfBenefit
      parameters:
      - name: patient
        in: query
        schema:
          type: string
      - name: type
        in: query
        schema:
          type: string
      - name: service-date
        in: query
        schema:
          type: string
      - name: _lastUpdated
        in: query
        schema:
          type: string
      - name: excludeSAMHSA
        in: query
        schema:
          type: boolean
      - name: includeTaxNumbers
        in: query
        schema:
          type: boolean
      responses:
        '200':
          description: Bundle of ExplanationOfBenefit
  /ExplanationOfBenefit/{id}:
    get:
      summary: Read Explanation Of Benefit by ID
      operationId: readExplanationOfBenefit
      tags:
      - ExplanationOfBenefit
      parameters:
      - name: id
        in: path
        required: true
        schema:
          type: string
      responses:
        '200':
          description: ExplanationOfBenefit resource
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/ExplanationOfBenefit'
components:
  schemas:
    ExplanationOfBenefit:
      type: object
      properties:
        resourceType:
          type: string
          enum:
          - ExplanationOfBenefit
        id:
          type: string
        status:
          type: string
        type:
          type: object
        use:
          type: string
        patient:
          type: object
        billablePeriod:
          type: object
        created:
          type: string
          format: date-time
        insurer:
          type: object
        provider:
          type: object
        diagnosis:
          type: array
          items:
            type: object
        procedure:
          type: array
          items:
            type: object
        item:
          type: array
          items:
            type: object
        total:
          type: array
          items:
            type: object
        payment:
          type: object
  securitySchemes:
    BearerAuth:
      type: http
      scheme: bearer
      bearerFormat: JWT
      description: AB2D uses SMART Backend Services with okta-issued JWT bearer tokens.

CMS — Centers for Medicare & Medicaid Services ExplanationOfBenefit API

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