Anthem
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.
APIs
Anthem Patient Access API
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-9...
Anthem Provider Directory API
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-...
Anthem Drug Formulary API
The Anthem Drug Formulary API provides access to prescription drug formulary data via HL7 FHIR R4, including covered medications, cost tiers, prior authorization requirements, a...
Features
All Anthem interoperability APIs implement HL7 FHIR Release 4 standards with USCDI-conformant resource profiles.
Patient Access APIs use SMART on FHIR for secure OAuth2-based authorization allowing members to grant third-party app access.
Members can access their claims history, clinical notes, lab results, immunizations, and medication history through the Patient Access API.
Search for in-network providers by specialty, location, name, and plan type through the public Provider Directory API.
Use Cases
Enable member-authorized third-party health apps to aggregate claims, clinical, and formulary data from Anthem plans.
Allow care coordinators and providers to access member health history with member authorization for improved care transitions.
Enable applications to search Anthem's provider directory for in-network physicians, hospitals, and specialists.
Integrations
Anthem participates in the CommonWell Health Alliance for cross-organizational clinical data exchange.
Anthem participates in the Carequality interoperability framework for health data exchange between networks.