Payer to Payer API
Secure exchange of member data between health plans to support continuity of care during member transitions, per CMS interoperability requirements.
Overview
The Payer-to-Payer API enables secure, standards-based exchange of member data between health plans to support continuity of care during member transitions. It allows receiving payer systems to retrieve claims, encounters, and prior authorization information from previous payer systems through authorized workflows.
It aligns with CMS-recommended implementation guides - CPCDS, HL7® Da Vinci PDex, and FHIR® Bulk Data - and leverages HL7® FHIR® with SMART Backend Services Authorization.
Capability Statement
Developers can access the Acentra Health FHIR server capabilities for the Payer-to-Payer API through the CapabilityStatement endpoint:
View JSONThe CapabilityStatement describes the supported profiles, interactions, search parameters, and authorization and token endpoints.
API Access Setup
Clients can retrieve SMART configuration details by invoking the SMART configuration endpoint at /.well-known/smart-configuration, appended to the FHIR Base URL.
Getting an Access Token
The Payer to Payer API uses SMART Backend Services authorization. Request an access token from the token endpoint using the client_credentials grant.
| Header | Value |
|---|---|
| content-type | application/x-www-form-urlencoded |
| accept | application/json |
| Parameter | Value |
|---|---|
| scope | {scopes} |
| grant_type | client_credentials |
| client_id | {client_id} |
| client_secret | {client_secret} |
Operations
The Payer to Payer API supports the following operations.
Resources
$davinci-data-export bulk export operation - individual REST endpoints are not available for these profiles.Request Headers
All requests for Payer to Payer API profiles require the following headers:
| Header | Value |
|---|---|
| content-type | application/json |
| accept | application/json |
| authorization | Bearer {access_token} |
Sample Responses & Data
Important Information for Payer Systems
| Topic | Reference |
|---|---|
| CARIN Alliance Code of Conduct | https://www.carinalliance.com/our-work/trust-frameworkand-code-of-conduct/ |
| Privacy, Security and HIPAA | https://www.healthit.gov/topic/privacy-security-and-hipaa |
| ONC Model Privacy Notice | https://www.healthit.gov/topic/privacy-security-and-hipaa/model-privacy-notice-mpn |