General
BlueCross BlueShield of Minnesota (BCBS-MN) offers 2 APIs giving you the ability to build applications for our customers. The BlueCross BlueShield of Minnesota Patient Access API provides insights into Medical and Prescription costs, as well as Medical Clinical information.
To access the Patient Access API your application will be required to secure communication with the Blue Cross Blue Shield FHIR server through the SMART framework.
Our implementation of the Patient Access API takes direction from the following set of implementation guides:
- CARIN Consumer Directed Payer Data Exchange
- Da Vinci Payer Data Exchange
- US Core Implementation Guide
- DaVinci Payer Data Exchange (PDex) US Drug Formulary
The capability statement provides insights into our implementation of these implementation guides.
Claims & Encounter Data
The CARIN Consumer Directed Payer Data Exchange has been implemented per the SHALL requirements found in the implementation guide. If you’ve interfaced to this API in the past, you will have minimal (if not no) issues interfacing with our implementation.notable exceptions:
- when using _lastUpdated the entire timestamp is required (for example: 2021-06-21T09:57:43.133-04:00); results may be incorrect if only YYYY-MM-DD is used.
Clinical Data
The Da Vinci Payer Data Exchange (and the US Core Implementation Guide) has been implemented per the SHALL requirements found in the implementation guide. If you’ve interfaced to this API in the past, you will have minimal (if not no) issues interfacing with our implementation.notable exceptions:
- when using _lastUpdated the entire timestamp is required (for example: 2021-06-21T09:57:43.133-04:00); results may be incorrect if only YYYY-MM-DD is used.
Plan Coverage and Formularies
The DaVinci Payer Data Exchange (PDex) US Drug Formulary implementation guide is the basis for our solution. At this time our Drug Formulary API is heavily reliant on the capabilities of our Pharmacy Benefits Management (PBM) vendor (our vendor is Prime Therapeutics). The documentation they provided is very thorough so rather than trying to summarize it we will just share it. The implementation of the Drug Formulary is heavily inspired by the DaVinci Payer Data Exchange (PDex) US Drug Formulary implementation guide; however deviations do exist.
- One note, the system returned in the resource itself is often not reachable via its URL. The good news is the system and its codes are documented in the implementation guide itself.
Your application will not communicate with Prime, you will always communicate to the Blue Cross Blue Shield of Minnesota FHIR server. Just to further clarify, the [base URL] referenced in the IG should map back to the appropriate BCBS-MN environment (pre-production or production).
Base URLs
Pre-Production: https://preview-api.bluecrossmn.com/fhir/
Production: https://api.bluecrossmn.com/fhir/
Users You Can Use to Test
The following two users are set up for testing.
| User | Password | Type |
|---|---|---|
| MNDEPT1234 | Minnesota@12345 | Medicare |
| PASSWORDMN123 | Minnesota@123 | Medicare |