Anthem

name: Anthem
description: Anthem, Inc. (now operating as Elevance Health) is one of the largest health benefits companies in the United
  States, serving members through affiliated Blue Cross and Blue Shield health plans across multiple states including California,
  New York, Virginia, Georgia, and others. Anthem provides health insurance, pharmacy benefits, and behavioral health services
  to over 40 million members. Under CMS interoperability rules (CMS-9115-F), Anthem offers FHIR- based Patient Access and
  Provider Directory APIs.
image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/apis-json-logo.jpg
url: https://raw.githubusercontent.com/api-evangelist/anthem/refs/heads/main/apis.yml
created: '2026-03-23'
modified: '2026-04-19'
specificationVersion: '0.16'
tags:
- Blue Cross Blue Shield
- FHIR
- Health Benefits
- Health Insurance
- Healthcare
- Interoperability
- Fortune 100
apis:
- name: Anthem Patient Access API
  description: The Anthem Patient Access API provides members access to their personal health data via HL7 FHIR R4, as required
    by the CMS Interoperability and Patient Access Final Rule (CMS-9115-F). Members can authorize third-party apps to access
    their claims, clinical information, formulary data, and coverage details. Implements SMART on FHIR for authorization.
  image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/apis-json-logo.jpg
  humanURL: https://www.anthem.com/developer/
  baseURL: https://fhir.anthem.com/r4/
  tags:
  - FHIR
  - Health Insurance
  - Healthcare
  - Interoperability
  - Patient Access
  - SMART on FHIR
  properties:
  - type: Documentation
    url: https://www.anthem.com/developer/
  - type: Authentication
    url: https://www.anthem.com/developer/authentication/
  contact:
  - FN: Anthem Developer Support
    url: https://www.anthem.com/developer/
- name: Anthem Provider Directory API
  description: The Anthem Provider Directory API provides public access to provider directory information via HL7 FHIR R4,
    as required by CMS interoperability rules. Supports searching for in-network providers, facilities, and insurance plans.
    No authentication required for public directory access.
  image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/apis-json-logo.jpg
  humanURL: https://www.anthem.com/developer/
  baseURL: https://fhir.anthem.com/r4/
  tags:
  - FHIR
  - Healthcare
  - Interoperability
  - Provider Directory
  properties:
  - type: Documentation
    url: https://www.anthem.com/developer/
  contact:
  - FN: Anthem Developer Support
    url: https://www.anthem.com/developer/
- name: Anthem Drug Formulary API
  description: The Anthem Drug Formulary API provides access to prescription drug formulary data via HL7 FHIR R4, including
    covered medications, cost tiers, prior authorization requirements, and quantity limits for Anthem health plan formularies.
  image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/apis-json-logo.jpg
  humanURL: https://www.anthem.com/developer/
  baseURL: https://fhir.anthem.com/r4/
  tags:
  - Drug Formulary
  - FHIR
  - Healthcare
  - Pharmacy
  properties:
  - type: Documentation
    url: https://www.anthem.com/developer/
  contact:
  - FN: Anthem Developer Support
    url: https://www.anthem.com/developer/
maintainers:
- FN: Kin Lane
  email: info@apievangelist.com
  X: apievangelist
  url: https://apievangelist.com
common:
- type: LinkedIn
  url: https://www.linkedin.com/company/antheminc
- type: Portal
  url: https://www.anthem.com
- type: Signup
  url: https://www.anthem.com/developer/register/
- type: TermsOfService
  url: https://www.anthem.com/legal/terms-and-conditions/
- type: PrivacyPolicy
  url: https://www.anthem.com/legal/privacy-policy/
- type: Features
  data:
  - name: FHIR R4 Compliance
    description: All Anthem interoperability APIs implement HL7 FHIR Release 4 standards with USCDI-conformant resource profiles.
  - name: SMART on FHIR Authorization
    description: Patient Access APIs use SMART on FHIR for secure OAuth2-based authorization allowing members to grant third-party
      app access.
  - name: Claims and Clinical Data
    description: Members can access their claims history, clinical notes, lab results, immunizations, and medication history
      through the Patient Access API.
  - name: Provider Directory Search
    description: Search for in-network providers by specialty, location, name, and plan type through the public Provider Directory
      API.
- type: UseCases
  data:
  - name: Member Health Apps
    description: Enable member-authorized third-party health apps to aggregate claims, clinical, and formulary data from Anthem
      plans.
  - name: Care Coordination
    description: Allow care coordinators and providers to access member health history with member authorization for improved
      care transitions.
  - name: Provider Lookup
    description: Enable applications to search Anthem's provider directory for in-network physicians, hospitals, and specialists.
- type: Integrations
  data:
  - name: CommonWell Health Alliance
    description: Anthem participates in the CommonWell Health Alliance for cross-organizational clinical data exchange.
  - name: Carequality Framework
    description: Anthem participates in the Carequality interoperability framework for health data exchange between networks.