aid: independence-blue-cross name: Independence Blue Cross description: >- Independence Blue Cross (IBX) is the Blue Cross Blue Shield Association licensee for southeastern Pennsylvania (Bucks, Chester, Delaware, Montgomery, and Philadelphia counties) and a subsidiary of Independence Health Group, Inc., the parent holding company that consolidated IBX, AmeriHealth (commercial, including AmeriHealth New Jersey and the AmeriHealth Administrators TPA business), and the AmeriHealth Caritas family of Medicaid managed care plans in 2013. The company has called Philadelphia home for more than 85 years, serves nearly three million members directly, and — through Independence Health Group — supports roughly nine million covered lives across commercial, Medicare Advantage, Medicaid, CHIP, dental, vision, and behavioral health lines of business. Independence Health Group reported consolidated revenue of $36.3 billion for 2025. To satisfy the CMS Interoperability and Patient Access final rule (CMS-9115-F), IBX publishes three HL7 FHIR R4 (4.0.1) APIs from its `eapics.ibx.com` gateway and developer portal at `devportal.ibx.com`: a SMART-on-FHIR / OAuth 2.0 secured Patient Access API for Medicare Advantage and Keystone HMO CHIP members, a public Da Vinci PDex Plan-Net Provider Directory API, and a public Da Vinci US Drug Formulary (USDF) API. The provider also publishes monthly Transparency in Coverage machine-readable files (in-network rates, allowed amounts, prescription drugs) for three carrier brands — Keystone Health Plan East, QCC Insurance Company, and Independence Assurance Co, Inc. url: https://raw.githubusercontent.com/api-evangelist/independence-blue-cross/refs/heads/main/apis.yml type: Index image: https://kinlane-productions2.s3.amazonaws.com/apis-json/apis-json-logo.jpg tags: - Healthcare - Health Insurance - Blue Cross Blue Shield - Managed Care - Medicare - Medicare Advantage - Medicaid - CHIP - Commercial - Dental - Vision - Behavioral Health - Pharmacy Benefits - Interoperability - FHIR - SMART On FHIR - CMS - Patient Access - Provider Directory - Drug Formulary - Transparency In Coverage created: '2024-01-01' modified: '2026-05-23' specificationVersion: '0.19' apis: - aid: independence-blue-cross:patient-access-api name: Independence Blue Cross Patient Access FHIR API description: >- HL7 FHIR R4 (4.0.1) Patient Access API published to satisfy the CMS Interoperability and Patient Access final rule (CMS-9115-F). Enables Independence Medicare Advantage and Keystone HMO CHIP members (or their personal representatives) to consent and share clinical, claims, encounter, coverage, medication, immunization, and demographic data with registered third-party applications. Conforms to the CARIN for Blue Button (CARIN BB), Common Payer Consumer Data Set (CPCDS), US Core 3.1.1, and Da Vinci PDex profiles. Secured by SMART App Launch 1.0.0 over OAuth 2.0 / OpenID Connect; production access requires developer registration and CMS-aligned attestation. humanURL: https://devportal.ibx.com/documentation/ baseURL: https://eapics.ibx.com/patient/v1/fhir tags: - Patient Access - FHIR - SMART On FHIR - Medicare Advantage - CHIP - CMS properties: - type: Portal url: https://devportal.ibx.com/ - type: Documentation url: https://devportal.ibx.com/documentation/ - type: Swagger url: https://www.ibx.com/scripts/custom/swagger/cmsSwagger.json - type: CapabilityStatement url: https://eapics.ibx.com/patient/v1/fhir/metadata - type: SmartConfiguration url: https://eapics.ibx.com/patient/v1/fhir/.well-known/smart-configuration - type: AuthorizeURL url: https://member.ibx.com/patientaccesssvc/oauth2/v1/authorize - type: TokenURL url: https://eapics.ibx.com/oauth2/v2/token - type: Registration url: https://devportal.ibx.com/cmssignin/ - type: TermsOfService url: https://www.ibx.com/htdocs/custom/tnc/Developer%20Portal%20TandC.pdf - type: ContactEmail url: mailto:AppOnboardingSupport@ibx.com - type: OpenAPI url: openapi/independence-blue-cross-patient-openapi.yml - type: SpectralRules url: rules/independence-blue-cross-rules.yml - type: NaftikoCapability url: capabilities/independence-blue-cross-patient-access.yaml - type: NaftikoCapability url: capabilities/independence-blue-cross-claims-and-eob.yaml - type: JSONSchema url: json-schema/independence-blue-cross-patient-schema.json - type: JSONSchema url: json-schema/independence-blue-cross-coverage-schema.json - type: JSONSchema url: json-schema/independence-blue-cross-explanation-of-benefit-schema.json - aid: independence-blue-cross:provider-directory-api name: Independence Blue Cross Provider Directory FHIR API description: >- HL7 FHIR R4 (4.0.1) Provider Directory API satisfying the CMS Provider Directory requirement of the Interoperability and Patient Access final rule. Published as a Da Vinci PDex Plan-Net server (CapabilityStatement id `ibc-plan-net-metadata`, published 2021-05-28). Publishes Practitioner, PractitionerRole, Organization, OrganizationAffiliation, Location, HealthcareService, InsurancePlan, and Endpoint resources for the Independence Blue Cross provider and pharmacy network. Publicly queryable; no authentication or member consent required. humanURL: https://devportal.ibx.com/documentation/ baseURL: https://eapics.ibx.com/provider/v1/fhir tags: - Provider Directory - FHIR - Da Vinci - Plan-Net - CMS properties: - type: Portal url: https://devportal.ibx.com/ - type: Documentation url: https://devportal.ibx.com/documentation/ - type: Swagger url: https://www.ibx.com/scripts/custom/swagger/cmsSwagger.json - type: CapabilityStatement url: https://eapics.ibx.com/provider/v1/fhir/metadata - type: ImplementationGuide url: http://hl7.org/fhir/us/davinci-pdex-plan-net/ImplementationGuide/hl7.fhir.us.davinci-pdex-plan-net - type: OpenAPI url: openapi/independence-blue-cross-provider-openapi.yml - type: SpectralRules url: rules/independence-blue-cross-rules.yml - type: NaftikoCapability url: capabilities/independence-blue-cross-provider-directory.yaml - type: JSONSchema url: json-schema/independence-blue-cross-practitioner-schema.json - type: JSONSchema url: json-schema/independence-blue-cross-organization-schema.json - type: JSONSchema url: json-schema/independence-blue-cross-location-schema.json - aid: independence-blue-cross:formulary-api name: Independence Blue Cross Drug Formulary FHIR API description: >- HL7 FHIR R4 (4.0.1) Drug Formulary API satisfying the CMS Interoperability drug formulary publication requirement, published as a Da Vinci US Drug Formulary (USDF) server (CapabilityStatement id `usdf-server`, published 2021-06-03). Exposes covered drug lists, tiers, and prior authorization indicators via FHIR `List` and `MedicationKnowledge` resources. Publicly queryable; no authentication required. humanURL: https://devportal.ibx.com/documentation/ baseURL: https://eapics.ibx.com/formulary/v1/fhir tags: - Formulary - Drug Formulary - FHIR - Da Vinci - USDF - CMS - Pharmacy Benefits properties: - type: Portal url: https://devportal.ibx.com/ - type: Documentation url: https://devportal.ibx.com/documentation/ - type: Swagger url: https://www.ibx.com/scripts/custom/swagger/cmsSwagger.json - type: CapabilityStatement url: https://eapics.ibx.com/formulary/v1/fhir/metadata - type: ImplementationGuide url: http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary - type: OpenAPI url: openapi/independence-blue-cross-formulary-openapi.yml - type: SpectralRules url: rules/independence-blue-cross-rules.yml - type: NaftikoCapability url: capabilities/independence-blue-cross-medications-and-formulary.yaml - aid: independence-blue-cross:transparency-in-coverage name: Independence Blue Cross Transparency In Coverage Data description: >- Monthly machine-readable JSON files published under 45 CFR Part §147.211 / the Transparency in Coverage rule for three carrier brands operated by Independence Blue Cross: Keystone Health Plan East, QCC Insurance Company, and Independence Assurance Co, Inc. Files cover in-network negotiated rates, out-of-network allowed amounts, and prescription drug pricing across medical, dental, vision, pharmacy, and plan domains. humanURL: https://www.ibx.com/resources/for-members/transparency-in-coverage.html baseURL: https://www.ibx.com/cmstic/ tags: - Transparency In Coverage - Machine Readable Files - Pricing - Regulatory properties: - type: Index url: https://www.ibx.com/cmstic/?brand=khpe - type: Index url: https://www.ibx.com/cmstic/?brand=qcc - type: Index url: https://www.ibx.com/cmstic/?brand=iac - type: Regulation url: https://www.cms.gov/healthplan-price-transparency - aid: independence-blue-cross:website name: Independence Blue Cross Corporate Website description: >- Public corporate website for Independence Blue Cross hosting member, provider, employer, broker, and producer portals; product pages for Medicare Advantage, commercial, dental, and vision; the affiliates / Independence Health Group corporate page; and pointers to the CMS Interoperability developer portal at devportal.ibx.com. humanURL: https://www.ibx.com baseURL: https://www.ibx.com tags: - Website - Corporate properties: - type: Website url: https://www.ibx.com - type: AboutUs url: https://www.ibx.com/about-us - type: Affiliates url: https://www.ibx.com/about-us/affiliates - type: AnnualReports url: https://www.ibx.com/about-us/annual-reports - type: Newsroom url: https://news.ibx.com/ - type: DeveloperPortal url: https://devportal.ibx.com/ - type: ProviderResources url: https://www.ibx.com/resources/for-providers/index.html common: - type: Portal url: https://devportal.ibx.com/ - type: Website url: https://www.ibx.com - type: Documentation url: https://devportal.ibx.com/documentation/ - type: Swagger url: https://www.ibx.com/scripts/custom/swagger/cmsSwagger.json - type: Authentication url: https://eapics.ibx.com/patient/v1/fhir/.well-known/smart-configuration - type: Registration url: https://devportal.ibx.com/cmssignin/ - type: TermsOfService url: https://www.ibx.com/htdocs/custom/tnc/Developer%20Portal%20TandC.pdf - type: PrivacyPolicy url: https://www.ibx.com/privacy-policy - type: Login url: https://www.ibx.com/login - type: CMSFinalRule url: https://www.cms.gov/priorities/key-initiatives/burden-reduction/interoperability - type: CARINBlueButton url: https://hl7.org/fhir/us/carin-bb/history.html - type: DaVinciPDex url: https://hl7.org/fhir/us/davinci-pdex/history.html - type: DaVinciPlanNet url: http://hl7.org/fhir/us/davinci-pdex-plan-net/ImplementationGuide/hl7.fhir.us.davinci-pdex-plan-net - type: DaVinciUSDF url: http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary - type: USCore url: https://hl7.org/fhir/us/core/STU3.1.1/ - type: SMARTAppLaunch url: https://hl7.org/fhir/smart-app-launch/1.0.0/ - type: Affiliates url: https://www.ibx.com/about-us/affiliates - type: ContactUs url: mailto:AppOnboardingSupport@ibx.com - type: ContactSupport url: https://www.ibx.com/contact-us - type: NewsBlog url: https://news.ibx.com/ - type: TransparencyInCoverage url: https://www.ibx.com/resources/for-members/transparency-in-coverage.html - type: Facebook url: https://www.facebook.com/ibx - type: Twitter url: https://www.twitter.com/ibx - type: YouTube url: https://www.youtube.com/ibxphilly - type: Instagram url: https://www.instagram.com/ibxfearless/ - type: Pinterest url: https://pinterest.com/IBXBlueCross/ - type: AntiFraud url: https://www.ibx.com/anti-fraud - type: Plans url: plans/independence-blue-cross-plans-pricing.yml - type: RateLimits url: rate-limits/independence-blue-cross-rate-limits.yml - type: FinOps url: finops/independence-blue-cross-finops.yml - type: Vocabulary url: vocabulary/independence-blue-cross-vocabulary.yml - type: JSONLDContext url: json-ld/independence-blue-cross-context.jsonld - type: JSONStructure url: json-structure/independence-blue-cross-health-plan-structure.json - type: Features data: - name: HL7 FHIR R4 Patient Access API description: >- SMART on FHIR / OAuth 2.0 secured member access (Medicare Advantage and Keystone HMO CHIP populations) to AllergyIntolerance, CarePlan, Condition, Coverage, DiagnosticReport, Encounter, ExplanationOfBenefit, Goal, Immunization, Location, Medication, MedicationDispense, MedicationRequest, Observation, Organization, Patient, Practitioner, PractitionerRole, and Procedure FHIR R4 resources. - name: HL7 FHIR R4 Provider Directory API description: >- Public, unauthenticated Da Vinci PDex Plan-Net FHIR Provider Directory exposing Practitioner, PractitionerRole, Organization, OrganizationAffiliation, Location, HealthcareService, InsurancePlan, and Endpoint resources for the Independence Blue Cross network. - name: HL7 FHIR R4 Drug Formulary API description: >- Public Da Vinci USDF Drug Formulary surface exposing MedicationKnowledge and List resources for the Independence Blue Cross covered drug list. - name: SMART App Launch 1.0.0 OAuth 2.0 with PKCE description: >- SMART configuration advertises `client-public`, `sso-openid-connect`, `launch-standalone`, `client-confidential-symmetric`, `context-standalone-patient`, `permission-offline`, and `permission-patient` capabilities. Authorize at `member.ibx.com/patientaccesssvc/oauth2/v1/authorize`, exchange at `eapics.ibx.com/oauth2/v2/token`. - name: CARIN Blue Button / Da Vinci / US Core Conformance description: >- Patient Access aligns with CARIN BB, CPCDS, US Core 3.1.1, and Da Vinci PDex. Provider Directory implements Da Vinci PDex Plan-Net. Drug Formulary implements Da Vinci USDF. - name: Developer Portal Self-Service description: >- devportal.ibx.com provides documentation, registration (`/cmssignin/`), sandbox services, and per-app credentials. App onboarding support is at AppOnboardingSupport@ibx.com. - name: Transparency In Coverage Machine-Readable Files description: >- Monthly published in-network rate, allowed amount, and prescription drug JSON files for Keystone Health Plan East, QCC Insurance Company, and Independence Assurance Co, Inc. at `www.ibx.com/cmstic/?brand={khpe|qcc|iac}`. - name: No Public GitHub Organization description: >- Independence Blue Cross does not maintain a public api-evangelist-discoverable GitHub organization for its FHIR developer surface; SDKs, sample code, and documentation are distributed through the dev portal rather than open-source repositories. - type: UseCases data: - name: Member Health Record Aggregation description: >- Consumer health apps allow Independence Medicare Advantage and Keystone HMO CHIP members to consent to share their clinical, claims, encounter, medication, and immunization history with third-party personal health record (PHR) apps. - name: Provider Directory Lookups description: >- Member-facing tools, broker apps, and care navigation tools query the public Da Vinci Plan-Net Provider Directory FHIR API to find in-network Practitioners, PractitionerRoles, Organizations, and Locations across southeastern PA. - name: Drug Formulary Browsing description: >- Members, prescribers, and pharmacy apps query the public USDF Drug Formulary FHIR API to confirm whether a medication is covered, the tier, and any prior authorization requirements before filling. - name: Payer-To-Payer Data Sharing description: >- When a member switches plans, the Patient Access surface can inform payer-to-payer exchange workflows aligned with Da Vinci PDex to migrate clinical history. - name: Price Comparison & Cost Transparency description: >- Researchers, employers, and consumer cost-transparency tools ingest the monthly Transparency in Coverage machine-readable files for Keystone Health Plan East, QCC, and IAC to compare in-network rates and allowed amounts. - name: Clinical & Quality Reporting description: >- Population health partners ingest member-authorized FHIR data to support HEDIS measure capture, risk adjustment, care-gap closure, and SDOH reporting. - type: Integrations data: - name: Independence Health Group description: >- Independence Blue Cross is a subsidiary of Independence Health Group, Inc., the 2013 holding company that also owns AmeriHealth (commercial) and majority-owns AmeriHealth Caritas (Medicaid managed care). - name: AmeriHealth Caritas description: >- Majority-owned (61.3%) by Independence with Blue Cross Blue Shield of Michigan as a 38.7% co-owner; runs Medicaid managed care, CHIP, D-SNP, LTSS, and Marketplace plans across thirteen states plus DC. - name: AmeriHealth New Jersey description: >- Independence operates AmeriHealth Insurance Company of New Jersey, a commercial payer serving roughly 209,000 New Jersey members. - name: AmeriHealth Administrators description: >- National third-party administrator (TPA) serving self-funded health plans, carriers, and administrators with business process outsourcing. - name: Tandigm Health description: >- Independence-affiliated value-based primary care enablement company supporting coordinated, proactive care for primary care physicians. - name: Blue Cross Blue Shield Association description: >- Independence Blue Cross is an independent licensee of the Blue Cross Blue Shield Association serving Bucks, Chester, Delaware, Montgomery, and Philadelphia counties in PA. - name: CMS Interoperability Framework description: >- APIs exist to satisfy the CMS-9115-F Interoperability and Patient Access final rule for Medicare Advantage and Children's Health Insurance Program (CHIP) populations. - name: HL7 FHIR R4 description: >- All three APIs implement HL7 FHIR 4.0.1 with SMART App Launch 1.0.0 security, CARIN BB, Da Vinci PDex / Plan-Net, and Da Vinci USDF guidance. - name: SMART on FHIR / OAuth 2.0 / OIDC / PKCE description: >- Standard SMART App Launch authorization code flow and PKCE flow back the Patient Access security model. SMART configuration is published at the well-known endpoint on eapics.ibx.com. - name: Carrier Brands description: >- Underwriting carriers include Keystone Health Plan East, QCC Insurance Company, Independence Assurance Co, Inc., and Keystone Health Plan East HMO products. Each publishes its own Transparency in Coverage machine-readable files. - type: Solutions data: - name: Commercial Health Plans description: >- Group commercial coverage for individuals, families, small and mid-sized businesses, large employers, municipalities, unions, and education boards in southeastern Pennsylvania. - name: Medicare Advantage description: >- Keystone 65 HMO, Personal Choice 65 PPO, and related Medicare Advantage products including PA and re-entered NJ MA markets in 2024. Patient Access FHIR API is required for this population under CMS-9115-F. - name: Children's Health Insurance Program (CHIP) description: >- Keystone HMO CHIP covers eligible children in southeastern Pennsylvania under the Pennsylvania CHIP program; CHIP members are in scope for the Patient Access API. - name: Medicaid (Through AmeriHealth Caritas) description: >- Medicaid managed care delivered through the AmeriHealth Caritas subsidiary family (Keystone First, AmeriHealth Caritas Pennsylvania, AmeriHealth Caritas DC, AmeriHealth Caritas Delaware, AmeriHealth Caritas Louisiana, AmeriHealth Caritas North Carolina, AmeriHealth Caritas New Hampshire, AmeriHealth Caritas Ohio, AmeriHealth Caritas Florida, First Choice by Select Health of South Carolina, and Blue Cross Complete of Michigan). - name: Dental description: >- IBX Dental coverage offered through Keystone and United Concordia networks for commercial, Medicare, and individual buyers. - name: Vision description: >- Vision coverage and provider network delivered through partner vision networks for commercial and Medicare buyers. - name: Behavioral Health description: >- Behavioral health benefits embedded in commercial, Medicare Advantage, and Medicaid lines; PerformCare (operated by AmeriHealth Caritas) supports PA behavioral health. - name: Pharmacy Benefits description: >- Pharmacy benefits administration including the covered drug list (formulary) surfaced via the Drug Formulary FHIR API. maintainers: - FN: Kin Lane email: kin@apievangelist.com