name: Independence Blue Cross Vocabulary
description: >-
  Operational vocabulary that maps the Independence Blue Cross surface
  area (commercial, Medicare Advantage, Keystone HMO CHIP, dental,
  vision, behavioral health, pharmacy benefits) and its FHIR-based
  developer surface to the API Evangelist taxonomy. Aligns concepts,
  services, tools, and standards used across Independence Blue Cross
  and the Independence Health Group corporate family.
modified: '2026-05-23'
provider: Independence Blue Cross
providerId: independence-blue-cross
concepts:
  - name: Blue Cross Blue Shield Licensee
    description: Independence is an independent licensee of the Blue Cross Blue Shield Association.
  - name: Commercial Health Insurance
    description: Group commercial coverage for individuals, families, small/mid/large employers in southeastern PA.
  - name: Medicare Advantage
    description: Independence Keystone 65 HMO and Personal Choice 65 PPO Medicare Advantage products.
  - name: Children's Health Insurance Program (CHIP)
    description: Keystone HMO CHIP covers eligible Pennsylvania children.
  - name: Medicaid Managed Care
    description: Delivered through the AmeriHealth Caritas subsidiary family (Keystone First, etc.).
  - name: Dental Insurance
    description: IBX Dental coverage including Keystone and United Concordia network options.
  - name: Vision Insurance
    description: Vision benefits offered alongside commercial and Medicare products.
  - name: Behavioral Health
    description: Behavioral health benefits embedded in commercial, MA, and Medicaid lines.
  - name: Pharmacy Benefits
    description: Drug coverage including the IBX-published Drug Formulary FHIR API.
  - name: Patient Access API
    description: CMS-mandated FHIR R4 read API for member clinical, claims, and coverage data.
  - name: Provider Directory API
    description: CMS-mandated FHIR R4 public directory of contracted Practitioners, Organizations, and Locations.
  - name: Drug Formulary API
    description: CMS-mandated FHIR R4 public drug formulary surface.
  - name: SMART on FHIR / OAuth 2.0
    description: Authorization framework securing the Patient Access surface.
  - name: PKCE Flow
    description: Authorization Code with Proof Key for Code Exchange for mobile/SPA clients.
  - name: CARIN Blue Button
    description: Implementation guide for consumer-directed payer data exchange (ExplanationOfBenefit).
  - name: Common Payer Consumer Data Set (CPCDS)
    description: CARIN BB underlying data set for adjudicated claim and encounter data.
  - name: Da Vinci PDex
    description: Payer Data Exchange implementation guide for clinical payer-to-payer data sharing.
  - name: Da Vinci PDex Plan-Net
    description: Implementation guide for FHIR R4 payer provider directories; IBX Provider Directory conforms.
  - name: Da Vinci US Drug Formulary (USDF)
    description: Implementation guide for FHIR R4 drug formulary publication; IBX Formulary conforms.
  - name: USCDI v1 / US Core 3.1.1
    description: Core data set referenced by the IBX Patient Access CapabilityStatement.
  - name: Transparency In Coverage Machine-Readable Files
    description: Monthly JSON files of in-network rates, allowed amounts, and prescription drug pricing per carrier brand.
services:
  - name: IBX Member Portal
    url: https://www.ibx.com/login
  - name: IBX Provider Resources
    url: https://www.ibx.com/resources/for-providers/index.html
  - name: IBX Developer Portal
    url: https://devportal.ibx.com/
  - name: IBX Newsroom
    url: https://news.ibx.com/
  - name: IBX Transparency In Coverage Index (KHPE)
    url: https://www.ibx.com/cmstic/?brand=khpe
  - name: IBX Transparency In Coverage Index (QCC)
    url: https://www.ibx.com/cmstic/?brand=qcc
  - name: IBX Transparency In Coverage Index (IAC)
    url: https://www.ibx.com/cmstic/?brand=iac
tools:
  - name: SMART App Launcher (HL7)
    url: https://hl7.org/fhir/smart-app-launch/1.0.0/
  - name: HAPI FHIR Validator
    url: https://hapifhir.io/
  - name: Inferno (ONC) FHIR test harness
    url: https://inferno.healthit.gov/
  - name: Postman
    url: https://www.postman.com/
  - name: Spectral (linting)
    url: https://stoplight.io/open-source/spectral
standards:
  - name: HL7 FHIR R4 (4.0.1)
    url: https://hl7.org/fhir/R4/
  - name: SMART App Launch 1.0.0
    url: https://hl7.org/fhir/smart-app-launch/1.0.0/
  - name: US Core 3.1.1
    url: https://hl7.org/fhir/us/core/STU3.1.1/
  - name: CARIN Blue Button
    url: https://hl7.org/fhir/us/carin-bb/history.html
  - name: Da Vinci PDex
    url: https://hl7.org/fhir/us/davinci-pdex/history.html
  - name: Da Vinci PDex Plan-Net
    url: http://hl7.org/fhir/us/davinci-pdex-plan-net/ImplementationGuide/hl7.fhir.us.davinci-pdex-plan-net
  - name: Da Vinci US Drug Formulary
    url: http://hl7.org/fhir/us/davinci-drug-formulary/ImplementationGuide/hl7.fhir.us.davinci-drug-formulary
  - name: USCDI v1
    url: https://www.healthit.gov/isp/united-states-core-data-interoperability-uscdi#uscdi-v1
  - name: CMS Interoperability and Patient Access Final Rule (CMS-9115-F)
    url: https://www.cms.gov/priorities/key-initiatives/burden-reduction/interoperability
  - name: HIPAA Privacy & Security Rules
    url: https://www.hhs.gov/hipaa/for-professionals/index.html
maintainers:
  - FN: Kin Lane
    email: kin@apievangelist.com