generated: '2026-07-18'
method: searched
source: >-
  https://clevercarehealthplan.com/fhir-api-developer-resources/ ,
  https://fhir.clevercarehealthplan.com/r4/metadata ,
  https://fhir-portal.clevercarehealthplan.com/api-docs/ExplanationOfBenefit.html
standards:
  - id: hl7-fhir-r4
    conforms: true
    evidence: CapabilityStatement fhirVersion 4.0.1; application/fhir+json responses.
  - id: smart-on-fhir
    conforms: true
    evidence: CapabilityStatement security.service SMART-on-FHIR; smart-configuration published.
  - id: oauth2
    conforms: true
    evidence: OAuth 2.0 authorization_code and client_credentials flows with PKCE S256.
  - id: oidc
    conforms: true
    evidence: sso-openid-connect capability; openid scope; OpenID Connect discovery.
  - id: carin-bb
    conforms: true
    evidence: ExplanationOfBenefit conforms to C4BB Inpatient/Outpatient/Pharmacy/Professional profiles.
  - id: cms-9115-f
    conforms: true
    evidence: Patient Access API and Provider Directory API per CMS Interoperability and Patient Access final rule.
  - id: us-core
    conforms: true
    evidence: US Core FHIR profiles underpin CMS-9115-F Patient Access implementations (Patient/Coverage).
  - id: hipaa
    conforms: true
    evidence: Medicare Advantage covered entity; HIPAA privacy practices published.
  - id: rfc9457-problem-details
    conforms: false
    evidence: Errors use FHIR OperationOutcome, not application/problem+json.
compliance_program:
  published: true
  url: https://clevercarehealthplan.com/medicare-compliance/
  posture:
    - CMS Interoperability and Patient Access final rule (CMS-9115-F)
    - HIPAA (Notice of Privacy Practices)
    - Medicare Advantage compliance program