Developer-friendly, standards-based APIs that enable Third Party applications to connect their applications or programs to MVP Health care data. These API’s put the power of data in the hands of our members to make informed decisions, cut down silos in health care, and foster innovation in health care.

These are a result of the US 21st Century Cures Act and the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) Interoperability Patient Access Rules.

MVP Health Care interoperability APIs enable MVP Health Care members to consent to have their data shared with Third Party applications. They also allow Third Party application owners to connect to provider and pharmacy directories.

MVP Health Care Interoperability APIs provide the following functionality:

• Enable developers to register member-facing applications
• Enable members to provide consent for application(s) of their choice to access their data
• Use the latest HL7 FHIR standards for member data and OAuth 2.0 / Open ID Connect
• Use the latest HL7 FHIR standards for sharing public non-member specific data
• Present data elements via the Patient Access API using nationwide United States Core Data for Interoperability (USCDI) standard health data classes and component data elements for national interoperability and information exchange
• Support the SMART on FHIR Application Framework and protocols

Registration and Authorization

To use the MVP Interoperability APIs, developers must register with MVP Health Care.

Once MVP approves registration requests, the application developer will receive a Client ID and Client Secret. Client secrets must be kept confidential and may only be used if it can be kept confidential, such as in communication between your server and the MVP Health care interoperability APIs.

If you are denied registration, or if you have questions regarding your denial or reapplication, please contact MVP eSupport at 1-888-656-5695, option 3. Reference the support ticket number associated with the notification you received if available.

Patient Access API

The Patient Access API is a CMS-regulated API specifically for Medicare Advantage organizations, Medicaid fee-for-serve (FFS) programs, Medicaid Managed care plans, Children’s Health Insurance Program (CHIP) fee-for-serve (FFS) programs, CHIP managed care entities, and Quality Health Plan issues on the Federally-Funded Exchanges (FFEs). This API aims to allow widespread access to claims, encounter, and clinical data elements in a standards-based API as documented in the latest HL7 FHIR Guidelines from 1/1/2016 to present.

The Patient Access API follows the following supporting Implementation Guides (IG’s):

• CARIN Consumer Directed Payer Data Exchange IG (also referred to as the CARIN IG for Blue Button® )
• HL7 FHIR DaVinci PDex IG
• HL7 FHIR DaVinci PDex US Formulary IG
• US Core Implementation Guide (FHIR IG)

Patient Access API Authorization

The process of getting data from a FHIR server that supports the Patient API starts with getting the Capability Statement of the FHIR server or using the Well-Known SMART on FHIR configuration of the server. Please see the HL7 Resource Capability Statement or SMART On FHIR Authorization Sequence for more details.

Examples of resources MVP supports with data for the Patient Access API include:

• AllergyIntolerance
• CarePlan
• Condition
• Coverage
• DiagnosticReport
• DocumentReference
• Encounter
• ExplanationOfBenefit
• Immunization
• Location
• Medication
• MedicationStatement
• Observation
• Observation
• Organization
• Patient
• Practitioner
• PractitionerRole
• Procedure
• ServiceRequest

Instructions:

1. Retrieve the capability statement from MVP’s server
2. Review the “authorize” and “token” endpoints from the Capability Statement. They should look like the following.

   Patient Capability Statement

   	
   		
   			"url": "http://fhir-registry.smarthealthit.org/StructureDefinition/oauth-uris",
   									"extension": [
   										{
   											"url": "authorize",
   											"valueUri": "https://azapp-healthshare-fhirproxy-prod-001.azurewebsites.net/mvpb2cprod.onmicrosoft.com/B2C_1A_SignInHealthshare/oauth2/v2.0/authorize"
   										},
   										{
   											"url": "token",
   											"valueUri": "https://azapp-healthshare-fhirproxy-prod-001.azurewebsites.net/mvpb2cprod.onmicrosoft.com/B2C_1A_SignInHealthshare/oauth2/v2.0/token"
   										}
   									]
   						\
   		
   	

3. Retrieve the Well-Known SMART on FHIR configuration.
4. Retrieve the authorization and token endpoints from the Well-Known configuration. They should look like the following.

   Well-Known Configuration Patient

   	
   				{
   					"authorization_endpoint": "https://azapp-healthshare-fhirproxy-prod-001.azurewebsites.net/mvpb2cprod.onmicrosoft.com/B2C_1A_SignInHealthshare/oauth2/v2.0/authorize",
   					"token_endpoint": "https://azapp-healthshare-fhirproxy-prod-001.azurewebsites.net/mvpb2cprod.onmicrosoft.com/B2C_1A_SignInHealthshare/oauth2/v2.0/token",
   					"token_endpoint_auth_methods": [
   						"client_secret_post"
   					],
   					"scopes_supported": [
   						"openid",
   						"profile",
   						"email",
   						"address",
   						"phone",
   						"federated_sso",
   						"fhirUser",
   						"launch",
   						"launch/patient",
   						"need_patient_banner",
   						"offline_access",
   						"openid",
   						"patient/*.read",
   						"profile",
   						"user/*.read",
   						"user/*.write"
   					],
   					"response_types_supported": [
   						"code"
   					],
   					"capabilities": [
   						"client-public",
   						"client-confidential-symmetric",
   						"context-standalone-patient",
   						"launch-standalone",
   						"permission-patient",
   						"permission-offline"
   					]
   				}
   				
   			

5. Use the token and authorize endpoints to perform the SMART on FHIR launch sequence. Please reference the SMART App Launch Framework and the SMART On FHIR Authorization Sequence for documentation.

Example Calls

Third Party application developers can use FHIR operations like the ones listed below (plain text) with the access token obtained from the SMART On FHIR Authorization Sequence to get data from the Patient API

Provider Directory API

The Provider Directory API includes provider directory information that must be made publicly available as part of CMS regulated payer requirements. This information is publicly available and accessible via APIs for Third Party application developers to develop service(s) that help patients find providers and services for their own care and treatment in addition to the overarching goal of enabling clinicians to locate providers for better care coordination. The Provider Directory API follows the supporting HL7 PDEX Payer Network Implementation Guide.

MVP Provider Directory API Discovery and Access

The MVP Provider Directory API conforms to the HL7 PDEX Payer Network Implementation Guide. Examples of resources that MVP supports with data for the Provider Directory API include:

• InsurancePlan
• Location
• Organization
• Practitioner
• PractitionerRole

To get started, access the Provider Directory API Capability Statement. The result should look like the following:

	
	{
		"resourceType": "CapabilityStatement",
		"id": "MVPProviderDirectoryFHIRAPI",
		"meta": {
			"lastUpdated": "2021-06-09T19:36:27Z",
			"versionId": "8"
		},
		"url": "https://api.mvphealthcare.com/provdirfhirapi/metadata",
		"version": "1",
		"name": "MVP Healthcare Provider Directory FHIR Server CapabilityStatement",
		"status": "active",
		"experimental": false,
		"date": "2021-05-28",
		"publisher": "MVP Healthcare",
		"kind": "instance",
		"software": {
			"name": "InterSystems FHIR Server",
			"version": "2020.2"
		},
		"implementation": {
			"description": "MVP Healthcare Provider Directory FHIR Server",
			"url": "https://api.mvphealthcare.com/provdirfhirapi"
		},
		"fhirVersion": "4.0.1",
		"format": [
			"xml",
			"json"
		],
	
	

Example Calls

Third Party application developers can use FHIR operations like the ones listed below (plain text) with the access token obtained from the SMART On FHIR Authorization Sequence to get data from the Patient API

MVP Plan Coverage and Formulary API

The MVP Plan Coverage and Formulary API includes a subset of data such as pharmacy formulary information and plan data per the Provider Directory API requirements and overarching legislation. The Plan Coverage and Formulary Specifications (part of the Patient Access API) follow the HL7 DaVinci Payer Data Exchange US Drug Formulary Implementation Guide.

MVP Plan Coverage and Formulary API Discovery and Access

The MVP Formulary API conforms to the HL7 DaVinci Payer Data Exchange US Drug Formulary Implementation Guide. Examples of resources that MVP supports with data for the Formulary API include:

• List
• MedicationKnowledge

To get started, access the Formulary API Capability Statement. The result should look like the following:

	
	{
		"resourceType": "CapabilityStatement",
		"id": "MVPFormularyFHIRAPI",
		"meta": {
			"lastUpdated": "2021-06-09T19:36:26Z",
			"versionId": "8"
		},
		"url": "https://api.mvphealthcare.com/formularyfhirapi/metadata",
		"version": "1",
		"name": "MVP Healthcare Plan Coverage & Formularies FHIR Server CapabilityStatement",
		"status": "active",
		"experimental": false,
		"date": "2021-05-28",
		"publisher": "MVP Healthcare",
		"kind": "instance",
		"software": {
			"name": "InterSystems FHIR Server",
			"version": "2020.2"
		},
		"implementation": {
			"description": "MVP Healthcare Plan Coverage & Formularies FHIR Server",
			"url": "https://api.mvphealthcare.com/formularyfhirapi"
		},
		"fhirVersion": "4.0.1",
		"format": [
			"xml",
			"json"
		],
	
	

Example Calls

Third Party application developers can use FHIR operations like the ones listed below (plain text) with the access token obtained from the SMART On FHIR Authorization Sequence to get data from the Patient API

To see more real-world examples, visit DaVinci Payer Data Exchange US Drug Formulary.

References

• Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, and Health Care Providers
• CMS Policies and Technology for Interoperability and Burden Reduction
• CMS Interoperability and Patient Access Fact Sheet