Third party payer information in Blue Button API

[John Noss]

I have been trying out the Blue Button API reading patient, claim and coverage information. I can see in the synthetic data that some patients have Part C and Part D coverage, which are normally third party (non-CMS) Medicare Advantage and Prescription Drug Plans. Is it possible to also determine the insurance carrier and the plan for these use cases?

Also is there any integration with Medigap coverage in Blue Button, or is it only Part C and Part D coverage?

[Developer Group for CMS Blue Button API]

Hello,

v1/v2 of the Blue Button API (currently in production) does not have comprehensive Part C and Part D coverage data. However, we will soon be rolling out v3 of our API which will have additional coverage data, including Part C and D data. You should be able to see the insurance carrier and plan for Medicare enrollees (though you may need to cross reference plan numbers to get human-readable plan/carrier info).

We do not currently support Medigap data in any version of the API, but this has been something we’ve looked into, so it’s possible we could support it in the future.

- Blue Button API Team