slug: cms
provider: Centers for Medicare and Medicaid Services
generated_by: planning/capability-mapping/scripts/classify_capabilities.py
model: claude-opus-5
frame:
- Healthcare Providers
min_confidence: 0.7
capability_model:
  source: https://github.com/vincentmakes/turbo-ea-capabilities
  license: CC-BY-4.0
  attribution: Turbo EA Capabilities by Vincent Verdet — Turbo EA, https://github.com/vincentmakes/turbo-ea-capabilities,
    CC BY 4.0
  notice: NOTICE
edge_count: 4
edges:
- tag: Coverage
  spec_file: cms-coverage-api-openapi.yml
  capability_id: BC-2800.30
  capability_id_l1: BC-2800
  capability_name: Eligibility & Benefits Verification
  confidence: 0.7
  evidence: GET /Coverage  searchCoverage — "delivers Medicare Part A, B, and D claims data" via "HL7
    FHIR R4 API"
  reason: FHIR Coverage resource exposes a beneficiary's insurance coverage details, which is the data
    substrate for verifying insurance coverage and benefits before service. Moderate confidence since
    the API is a payer-side data feed rather than a provider verification workflow.
  recovered_from: healthcare-vertical-edges.json
- tag: ExplanationOfBenefit
  spec_file: cms-explanationofbenefit-api-openapi.yml
  capability_id: BC-2900.60
  capability_id_l1: BC-2900
  capability_name: Healthcare Interoperability Operations
  confidence: 0.7
  evidence: '"standards-based HL7 FHIR R4 API that delivers Medicare Part A, B, and D claims data ...
    Beneficiaries authorize sharing via OAuth 2.0"; GET /ExplanationOfBenefit "Search ExplanationOfBenefit"'
  reason: A FHIR R4 read/search endpoint for claims resources, consumed by third-party apps under patient
    authorisation. That is health-information-exchange / FHIR endpoint operation and patient-initiated
    data sharing rather than any care-delivery or billing execution capability.
- tag: group
  spec_file: cms-group-api-openapi.yml
  capability_id: BC-2900.60
  capability_id_l1: BC-2900
  capability_name: Healthcare Interoperability Operations
  confidence: 0.7
  evidence: GET /api/v1/Group/{groupId}/$export — 'Start FHIR STU3 data export job for the specified group
    identifier and resource type(s)'
  reason: Operations are FHIR bulk data export ($export) endpoints for sharing claims/clinical resources
    with authorised data consumers, which is the operation of FHIR endpoints and health data exchange
    (Healthcare Interoperability Operations). Some ambiguity because it is also a data-distribution mechanism
    rather than provider-side record keeping.
- tag: patient
  spec_file: cms-patient-api-openapi.yml
  capability_id: BC-2900.60
  capability_id_l1: BC-2900
  capability_name: Healthcare Interoperability Operations
  confidence: 0.7
  evidence: GET /Patient searchPatient 'Search Patient'; GET /api/v1/Patient/$export 'Start FHIR STU3
    data export job'
  reason: 'FHIR Patient search/read plus patient-scoped bulk export: operation of FHIR endpoints for exchanging
    patient records with external applications, i.e. healthcare interoperability operations rather than
    registration workflow (no create/update of demographics).'