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Evolution of Patient Access to Claims Data Related to the CARIN IG for Blue Button®

Implementation Guide Background

The CARIN for Blue Button Framework was designed to answer the challenge for health plans to ‘meet or exceed’ the CMS Blue Button 2.0 capabilities. The CMS Blue Button® 2.0 project provides over 53 million Medicare fee-for-service beneficiaries access to their electronic claims information. The goal of the CARIN Alliance Health Plan Workgroup is to develop an agreed upon set of data fields to exchange with consumers and a FHIR-based implementation guide for health plans and consumer facing applications to use to implement the API.

This implementation guide describes the CARIN for Blue Button®Framework and Common Payer Consumer Data Set (CPCDS), providing a set of resources that payers can display to consumers via a FHIR API.


Consumer-directed exchange occurs when a consumer or an authorized caregiver invokes their HIPAA Individual Right of Access (45 CFR 164.524) and requests their digital health information from a HIPAA covered entity (CE) via an application or other third-party data steward. 

Technical Workflow


  • Consumer (aka Subscriber, Beneficiary, Patient, or Personal Representative)
  • Consumer App (aka digital third-party application selected by and primarily for the Consumer with a consumer-facing user interface)
  • Health Plan API (aka Payer, Covered Entity)
  • Health Plan’s Identity and Access Authorization server


  1. Consumer App presents a list of potential Payers / Health Plans that can be accessed by the Consumer.
  2. Consumer selects the Payer / Health Plan.
  3. Consumer App opens the link to the Health Plan's Identity and Access Authorization server.
  4. Consumer enters the credentials.
  5. Health Plan's Identity and Access Authorization server validates the credentials, generates and returns to the Consumer App an OIDC token with Consumer and authorized patient/beneficiary identities encoded.
  6. Consumer App successfully links the user to the Payer / Health Plan and notifies the Consumer.
  7. Consumer requests the Consumer App to fetch Explanation Of Benefit records.
  8. Consumer App generates and sends to the Health Plan's CARIN IG for Blue Button® enabled FHIR API a request (which includes Patient ID, and token from the step #5) to fetch the Explanation Of Benefit (EOB) and supporting reference FHIR resources.
  9. Health Plan's CARIN IG for Blue Button® enabled FHIR API responds with a bundle of the requested EOB and supporting reference FHIR resources.
  10. Consumer App presents the EOB and supporting reference FHIR resources to the Consumer.


PSS: PSS for CARIN Blue Button

STU2 (v 2.0.0): http://hl7.org/fhir/us/carin-bb/

Zulip channel" https://chat.fhir.org/login/#narrow/stream/204607-CARIN-Blue.20Button.20IG

Reference Implementation: 

The CARIN Blue Button IG Reference Implementation is now live! Please see below to access the RI:

The client is here: https://cpcds-client.lantanagroup.com/home

Client Auth:

Patient Access FHIR Server: https://cpcds-server.lantanagroup.com/fhir/

Client ID: 7d283a6c-6289-4f80-9dc4-df5e5a8b70af

Client Secret: ZYr0AserNMV3EOT5WlsQCrm1HmvR4b0AJyitFJxeYnJ03mpfjxnz5h8w3QsclvzxRuH2QBq29bjCDpsvp7EQEUxj1lACrRcm6k4N0Miv1Hx7oHIaMiLKm5QQyciQrfZSkvGKq5f3U3G5JYEy268NaSZeMLMksg6ZewFkTzwxHatBzx54Ud2P0XusA9dvpeATYmq4f0Po3oAzj337gAQC3aHBi3z05wSZq3GGRMrPBG3IjlpBuxEGTIedjUvtVuLc

Scopes: launch/patient patient/*.read offline_access openid fhirUser

User Credentials (CPCDS Server Login):

Username: Patient1

Password: password

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