CareSource Interoperability Overview

CareSource’s Interoperability APIs are developer-friendly, FHIR-based APIs that allow third-party applications and vendors to connect their systems to CareSource patient and provider information.

These Interoperability APIs enable CareSource members to consent to the sharing of their data with a third-party application of their choice. Additionally, these APIs allow third-party application owners to access publicly available data in provider and pharmacy directories.

CareSource’s APIs support the technology and functionality below:

  • Developers can register their member-facing applications
  • Members can provide consent to an application for access to their data within the specified scope
  • The HL7 FHIR (Fast Healthcare Interoperability Resource) standard is used for patient and publicly available provider data
  • Smart on FHIR is utilized for authorization flows related to member authorization

What is interoperability?

Healthcare interoperability is the ability for authorized patients, providers, payers, and third-party applications to securely exchange health information electronically using standardized APIs and data formats. 

CMS interoperability regulations require health plans to make specific health information available through standards-based APIs, primarily using FHIR® (Fast Healthcare Interoperability Resources). These requirements are intended to: 

  • Improve member access to health information 
  • Reduce administrative burden 
  • Improve care coordination 
  • Support payer-to-payer data exchange 
  • Increase transparency in the prior authorization process 
  • Enable automated healthcare workflows through industry-standard APIs and implementation guides 

Who is the page for?

This page is designed for provider organizations and their technical representatives who are responsible for implementing integrations with CareSource interoperability APIs. Typical users include IT administrators, EHR vendors, interoperability teams, application developers, and implementation partners. The resources provided here will help organizations understand API capabilities, review technical requirements, complete onboarding activities, prepare for testing, and obtain production access. Technical users should use this page as their primary source for implementation guidance and onboarding information. 

  • For member-focused or provider education materials, please refer to the dedicated Member and Provider Data Sharing pages. 
  • Member Data Sharing page – Coming soon 
  • Provider Data Sharing page – Coming soon

Applicable CMS guidelines 

CMS-9115-F
Overview: CMS-9115-F requires health plans to provide secure, standards-based access to healthcare data through FHIR® APIs. These requirements support member-authorized access to health information and public access to provider directory data. CareSource supports compliance through interoperable APIs, technical documentation, implementation resources, and integration guidance.

What changed: Introduced the Patient Access API and Provider Directory API to enable member-authorized access to health information and public access to provider directory data.

CMS-0057-F

Overview: CMS-0057-F expands healthcare interoperability requirements by enabling standards-based data exchange between payers and providers through FHIR® APIs. These requirements support provider access to patient information, payer-to-payer data exchange, and electronic prior authorization workflows. CareSource supports compliance through APIs, technical documentation, implementation resources, and integration guidance.

What changed: Introduced the Provider Access API, Payer-to-Payer API, and Prior Authorization APIs to support provider access to patient information, payer-to-payer data exchange, and electronic prior authorization workflows.

See the “Available APIs ” section for more information on the supported APIs supported by CareSource.  

Note: All API documentation gathered below is publicly accessible without required registration or authentication