# AmeriHealth Caritas

**Canonical:** https://apis.io/providers/amerihealth-caritas/  
**Website:** https://www.amerihealthcaritas.com  
**APIs profiled:** 25

AmeriHealth Caritas is one of the largest Medicaid managed care organizations in the United States, serving roughly five million members across Medicaid, Children's Health Insurance Program (CHIP), dual-eligible Medicare-Medicaid (D-SNP), Medicare-Medicaid LTSS, and Marketplace lines of business across thirteen states plus the District of Columbia. The company is owned jointly by Independence Blue Cross (majority) and Blue Cross Blue Shield of Michigan, operates state health plans under brands such as Keystone First, Select Health of South Carolina, Blue Cross Complete of Michigan, AmeriHealth Caritas Next, AmeriHealth Caritas VIP Care, and PerformCare, and exposes a set of HL7 FHIR R4 APIs through its developer portal at developer.amerihealthcaritas.com to satisfy the CMS Interoperability and Patient Access final rule (CMS-9115-F).

## Kin Score — 40.7 / 100 (developing)

Scored 2026-08-20 under rubric 0.12.0. Trend: flat (-3.6 from 44.3).

| Facet | Score |
|---|---|
| Discoverability | 50.0 |
| Contract Quality | 51.9 |
| Governance | 25.0 |
| Contract Governance | 25.0 |
| Operational Transparency | 36.8 |
| Developer Ergonomics | 33.3 |
| Commercial Clarity | 39.5 |
| Access Clarity | 39.5 |

Regulatory layer — **Health**: 21.3 (matched via tags).

## Agent readiness — 35.0 (agent-ready)

| Dimension | Value |
|---|---|
| Spec Presence | yes |
| Agentic Access | derived |
| Reversibility Documented | no |
| MCP Server | no |
| Auth Clarity | yes |
| Idempotency | no |
| Error Semantics | no |
| OpenAPI Examples | verified |
| Rate Limit Signal | documented |
| Event Surface Described | no |
| Agent Skills | no |
| Well Known Catalog | no |
| Consent Identity | no |
| Agent Card | no |
| Dry Run Mode | no |

## Access

Freemium · Self-serve signup — onboarding: self-serve, pricing: freemium, trial: no (confidence: high).

## APIs (25)

- **AmeriHealth Caritas Formulary FHIR API** — HL7 FHIR R4 Formulary API published to satisfy CMS-9115-F drug formulary publication requirements for Medicaid managed care and D-SNP populations. Covered drug lists, tier infor...
- **AmeriHealth Caritas Corporate Website** — Public corporate website for AmeriHealth Caritas, hosting the family-of-plans health plan finder, solutions overview, careers, member and provider portals for the federated stat...
- **AmeriHealth Caritas AllergyIntolerance API** — The AllergyIntolerance FHIR resource type
- **AmeriHealth Caritas Claim API** — The Claim FHIR resource type
- **AmeriHealth Caritas Condition API** — The Condition FHIR resource type
- **AmeriHealth Caritas Coverage API** — The Coverage FHIR resource type
- **AmeriHealth Caritas Encounter API** — The Encounter FHIR resource type
- **AmeriHealth Caritas ExplanationOfBenefit API** — The ExplanationOfBenefit FHIR resource type
- **AmeriHealth Caritas HealthcareService API** — The HealthcareService FHIR resource type
- **AmeriHealth Caritas Immunization API** — The Immunization FHIR resource type
- **AmeriHealth Caritas InsurancePlan API** — The InsurancePlan FHIR resource type
- **AmeriHealth Caritas List API** — The List FHIR resource type
- **AmeriHealth Caritas Location API** — The Location FHIR resource type
- **AmeriHealth Caritas Medication API** — The Medication FHIR resource type
- **AmeriHealth Caritas MedicationDispense API** — The MedicationDispense FHIR resource type
- **AmeriHealth Caritas MedicationKnowledge API** — The MedicationKnowledge FHIR resource type
- **AmeriHealth Caritas MedicationRequest API** — The MedicationRequest FHIR resource type
- **AmeriHealth Caritas Observation API** — The Observation FHIR resource type
- **AmeriHealth Caritas Organization API** — The Organization FHIR resource type
- **AmeriHealth Caritas OrganizationAffiliation API** — The OrganizationAffiliation FHIR resource type
- **AmeriHealth Caritas Patient API** — The Patient FHIR resource type
- **AmeriHealth Caritas Practitioner API** — The Practitioner FHIR resource type
- **AmeriHealth Caritas PractitionerRole API** — The PractitionerRole FHIR resource type
- **AmeriHealth Caritas Procedure API** — The Procedure FHIR resource type
- **AmeriHealth Caritas System Level Operations API** — Server-level operations

## Agentic access (1)

- **Amerihealth Caritas Agentic Access** — 622 operations · 269 acting

## Security (2)

- **Amerihealth Caritas Authentication** — openIdConnect · 1 scheme
- **Amerihealth Caritas Domain Security** — TLSv1.3 · HSTS · DNSSEC · DMARC

## Plans (1)

- **Amerihealth Caritas Plans Pricing**

## Use cases (6)

- **Member Health Record Aggregation** — Third-party consumer apps allow Medicaid, D-SNP, and Marketplace members to download and aggregate claims, encounters, medications, immunizations, and care plan data from AmeriH...
- **Provider Directory Lookups** — Care navigation apps, broker tools, and benefits portals query the public Provider Directory FHIR API to find AmeriHealth-Caritas-contracted Practitioners, PractitionerRoles, Or...
- **Drug Formulary Browsing** — Members and prescribers query the public Drug Formulary FHIR API to confirm whether a medication is covered, the tier, and any prior authorization requirements before filling.
- **Care Coordination Across Dual-Eligible Plans** — D-SNP / dual-eligible care managers reconcile Medicare and Medicaid coverage, ExplanationOfBenefit, and Encounter data to coordinate Long-Term Services and Supports (LTSS) and b...
- **Payer-To-Payer Data Sharing** — When a member switches plans, the Patient Access surface can inform payer-to-payer exchange workflows aligned with Da Vinci PDex to migrate clinical history.
- **Population Health Reporting** — State Medicaid agencies and quality reporting partners consume aggregated, member-authorized FHIR data to support HEDIS, quality measure, and SDOH reporting.

## Tags

Healthcare, Health Insurance, Managed Care, Medicaid, Medicare, Dual Eligible, CHIP, LTSS, Behavioral Health, Pharmacy Benefits, Interoperability, FHIR, CMS, SMART on FHIR, Patient Access, Provider Directory

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Profiled by [API Evangelist](https://apievangelist.com) and published on [APIs.io](https://apis.io/providers/amerihealth-caritas/). Scores are computed from the provider's own public artifacts under a published rubric.