Blue Button API On Fast Healthcare Interoperability Resources

Blue Button Application Programming Interface on Fast Healthcare Interoperability Resources (BBAPI) increases electronic access to health care information by giving Medicare beneficiaries the ability to connect their Medicare Part A, Part B, and Part D claims information to applications that they trust. 

Applications, created by independent developers and not endorsed or certified by CMS, can be mobile applications, personal heath record platforms or research programs. These applications integrate with the BBAPI adding value for beneficiaries, providers, care organizations, and researchers to reduce patient burden, streamline information about different kinds of care over time, uncover new insights that can improve health outcomes, and the ability to access and monitor health information in one place.

The beneficiary's ability to see and receive their own health records is a legal right under the Health Insurance Portability and Accountability Act (HIPAA). 

The claims data in the BBAPI is obtained from the following source systems which are covered under their own PIA: Chronic Condition Warehouse (CCW), Medicare Multi-Carrier Claims System (MCS), Fiscal Intermediary Shared System (FISS), Accountable Care Organization-Operational System (ACO-OS).

Claims data maintained in the BBAPI includes explanation of benefits (EOB) for Part A, Part B and Part D claims data, coverage data (i.e., Medicare plan type) and patient information that includes name, date of birth, sex, race, address, and deceased date. Provider information includes mailing address and tax number. 

An encrypted non-reversible hash of the Health Insurance Claim Number (HICN) and Medicare Beneficiary Identification (MBI) number are only maintained and used for beneficiary matching.

System access information on beneficiaries including details of the user, data accessed, and application authorization is maintained in the system.

BBAPI regularly uses PII to retrieve system records including using personal identifiers such as the name and user ID number of CMS employees and direct contractors authorized to control and authenticate access to the system. 

Data is maintained (stored) in the system permanently.

BBAPI provides Fast Healthcare Interoperability Resources (FHIR)-formatted claims data for individual Medicare beneficiaries, to registered third-party applications with beneficiary authorization. (FHIR is a standard for exchanging healthcare information electronically). 

A Medicare beneficiary chooses an application to connect their Medicare claims information. The application redirects the beneficiary to the BBAPI for authorization. The beneficiary verifies their identity using their MyMedicare.gov username and password (NOTE: username and password for MyMedicare.gov are not maintained by BBAPI). The patient identifier (i.e., HICN and MBI) is sent to the BBAPI for beneficiary matching. Provider's mailing address and tax number is also used for matching.

Token-based authentication is used to allow the application to verify their identity, and in return receive a unique access token. The application must supply this token on every request made to the BBAPI on behalf of the beneficiary. 

Using the access token, the application makes a request to the BBAPI for the beneficiary data. BBAPI transmits the beneficiary data that includes, if applicable: explanation of benefits (EOB) for Part A, Part B and Part D claims data, coverage data (Medicare plan type) and patient information that includes name, date of birth, sex, race, address, and deceased date to the application. The data is then made available to the beneficiary using the application.

BBAPI collects and maintains system access information on beneficiaries that includes details of the user, data accessed and application authorization to validate every access made by an application to the BBAPI. 

BBAPI regularly uses PII to retrieve system records including using personal identifiers such as the name and user ID number of CMS employees and direct contractors authorized to control and authenticate access to the system. 

BBAPI regularly uses PII including using personal identifiers such as the hashes of the HICN and MBI to retrieve the claims data of Medicare beneficiaries.

• Name
• E-Mail Address
• Taxpayer ID
• Date of Birth
• Mailing Address
• Medical Records Number
• Other - Deceased Date, Sex, Race, HICN, MBI, CMS credentials (name and user ID)

• Employees
• Public Citizens
• Vendors/Suppliers/Contractors
• Patients
• Other - Providers

BBAPI is designed for external access that enables an authenticated beneficiary to grant access to their PII to one or more applications of their choice. Access granted by a beneficiary releases their PII to the application.

BBAPI regularly uses PII to retrieve system records including using personal identifiers such as the name and user ID number of CMS employees and direct contractors authorized to control and authenticate access to the system. 

Sections 1902(a)(6), 1142(c)(6) of Title XVIII of the Social Security Act

Sections 1842, 1862 (b) and 1874 of Title XVIII of the Social Security Act (42 United States Code (U.S.C.) 1395u, 1395y (b), and 1395kk)

Sections 1816, 1862 (b) and 1874 of Title XVIII of the Social Security Act (42 U.S.C. 1395(h), 1395y (b), and 1395kk)

Section 723 of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (Pub. L. 108-173)

Title IV of the Balanced Budget Act (Pub. L. 105-33).

• Members of the Public
• Private Sector

The claims data in the BBAPI is obtained from the following source systems which are covered under their own PIA: CCW, MCS, FISS, and ACO-OS. These systems are responsible for providing methods for individuals to opt-out of collection or use of PII.

A Medicare beneficiary chooses an application to connect their Medicare claims information. The application redirects the beneficiary to the BBAPI for authorization. The beneficiary verifies their identity using their MyMedicare.gov username and password (NOTE: username and password for MyMedicare.gov are not collected by BBAPI). The beneficiary is provided with an authorization screen. Within the authorization screen, the beneficiary has the option to approve or decline authorization. If the beneficiary approves authorization, token-based authentication is used to allow the application to verify their identity, and in return receive a unique access token. 

The application must supply this token on every API call (request) made to the BBAPI on behalf of the beneficiary. The application retains access to retrieve information for the beneficiary if the token remains valid. If a beneficiary revokes the authorization to their information, the token is invalidated, and the application will be unable to retrieve any information for the beneficiary. 

Medicare beneficiaries can revoke the authorization by using these methods:

Beneficiaries can access their MyMedicare.gov account and revoke the authorization to the application. 

Medicare Call Center agents can assist a beneficiary with revoking authorization to the application. Contact information: 1-800-MEDICARE (1-800-633-4227)

Beneficiaries can choose whether or not to share their personal information such as name, address, date of birth, race, and sex with the application. When the beneficiary reaches the authorization screen, radio buttons let a beneficiary select only one of two choices: share all your data or share healthcare data, but not personal info. The default selection is to share all data. If a beneficiary later decides they want to change their selection, they will need to repeat the authorization process.

The claims data in the BBAPI is obtained from the following source systems which are covered under their own PIA: CCW, MCS, FISS, and ACO-OS. 

BBAPI system administrators can revoke application credentials for concerns that PII has been inappropriately obtained, used, or disclosed. This would prevent the application from using the BBAPI to access information for any beneficiary that provided an authorization.

If a beneficiary has concerns that their PII has been inappropriately obtained, used, or disclosed, or that the PII is inaccurate, they can use these methods for resolution:

Beneficiaries can access their MyMedicare.gov account and revoke the authorization to the application. 

Beneficiaries can contact 1-800-MEDICARE (1-800-633-4227). Medicare call center agents have scripts available that can assist a beneficiary with a concern about an application that is connected to their information.

• Administrators: System administrators may access PII to manage system and troubleshoot potential issues.
• Developers: Developers may access PII in the process of managing and preparing data sets and data extracts.
• Contractors: Direct contractors authorized by CMS may access PII to conduct research under the assigned contract and manage system and troubleshoot potential issues.

BBAPI system administrators, developers and direct contractors may be required to review PII maintained in the system to validate the mapping of data. In these instances, PII is restricted to only those users who are needed to perform the necessary validation.

The BBAPI platform is designed to automate software deployment. Software can be deployed to application servers by source-controlled scripts, without manual intervention, enabling deployments to be closely monitored and avoiding the need to access PII.

Security information and event management (SIEM) tools are used to monitor access and detect anomalies. Any anomalies are addressed and resolved by contacting the user, modifying their user access, or by removing their access if no longer required. Activities of all users including system administrators are logged and reviewed to identify abnormal activities.

Security and privacy awareness training is provided to each user on an annual basis. All users are required to complete training to obtain a user account and annually thereafter.

Required training includes annual Department of Health and Human Services (HHS) Information Systems Security Awareness Training, annual HHS Privacy Training, reading, and attesting to the Rules of Behavior for Use of HHS Information Resources (HHS RoB)

Role-based training is required for those with significant information security and privacy responsibilities. BBAPI system administrators, developers and direct contractors are required to complete annual role-based training.

A sample list of role-based training includes Incident Response exercises, Contingency Planning exercises

Records are maintained in accordance with the National Archives and Records Administration (NARA) records schedule: DM-0440-2015-0008. Records are retained for 7 years unless longer retention is authorized.

BBAPI implements multi-tier architecture, separating different components of the system into subnets. Each subnet is separated by a firewall that is configured to deny all traffic, unless explicitly allowed.

Administrative controls include annual security and privacy training for the proper handling of information, configuration management, change management, periodic review of users, and deletion or revoking of user accounts.

Technical controls include multi-factor authentication, session locks, encryption, mutual transport layer security (TLS), firewalls, vulnerability scans, penetration testing, and monitoring.

Physical controls include a secure AWS data center, video surveillance, intrusion detection systems, uninterruptible power supply (UPS), back-up generators, environmental controls to maintain a constant operating temperature, smoke detection sensors, and sprinkler systems.

https://bluebutton.cms.gov/

https://sandbox.bluebutton.cms.gov/