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interop

API Documentation

UPMC Health Plan’s ONC Interoperability Developer Portal supports the following APIs: Patient Access, Rx Formulary, Provider and Pharmacy Directory, Explanation of Benefits and Clinical Data.

Resources

Connecting to Our Server

To use the UPMC Health Plan APIs, your application must comply with the ONC Cures Act Final Rule SMART on FHIR specification. You will need to complete the application registration form. You will then receive a Client ID and Client Secret with which to call UPMC Health Plan’s ONC Cures Act Final Rule APIs.

Patient Access API

The Patient Access API enables UPMC Health Plan members to securely exchange their health plan member information, which includes personal details like name, address, phone number, and date of birth with third party applications. This API conforms to the R4 FHIR standard.

  • Read
    https://api.upmchp.com/FHIR/R4/{resourceType}/{resourceId}
  • Search
    https://api.upmchp.com/FHIR/R4/{resourceType}?

Rx Formulary API

The Rx Formulary API enables UPMC Health Plan members to access the drugs covered by their health plan through a third-party application. A bulk data file will be returned to the third-party application. This API conforms to the R4 FHIR standard.

  • Read
    https://api.upmchp.com/FHIR/R4/Group/{groupId}/$export

Provider and Pharmacy Directory API

The Provider and Pharmacy Directory API is publicly available and does not require an application registration or member credentials to retrieve data. The API includes information about participating providers, healthcare facilities, urgent care centers, pharmacies, locations where rendered.

The provider directory will include the following types of provider data:

  • Provider Demographics
  • Provider Specialties and Roles
  • Provider Services Offered
  • Provider Office hours
  • Provider indicator if new patients are accepted
  • Provider Accepted network information
  • Hospital and Facility Hours
  • Hospital and Facility Locations
  • Hospital and Facility Services Offered
  • Hospital and Facility Networks Accepted
  • Pharmacy Locations
  • Pharmacy Hours
  • Read
    https://api.upmchp.com/FHIR/R4/Group/{groupId}/$export

Explanation of Benefits API

The Explanation of Benefit API enables UPMC Health Plan members to access explanation of benefits (EOB) through third party applications. EOBs include the payments UPMC Health Plan has made on behalf of a member as well as a description of the healthcare services provided to the member. This API conforms to the R4 FHIR standard. The API returns a bulk data file.

  • Read
    https://api.upmchp.com/FHIR/R4/{resourceType}/{resourceId}
  • Search
    https://api.upmchp.com/FHIR/R4/{resourceType}?

Clinical Data API

The Clinical Data API enables UPMC HealthPlan members to access their clinical and encounter data in USCDI V1 format through third party applications. This includes Allergies and Intolerances, Assessment and Plan of Treatment, Care Team Member(s), Clinical Notes, Goals, Health Concerns, Immunizations, Laboratory, Medications, Patient Demographics, Problems, Procedures, Provenance, Smoking Status, Unique Device Identifier(s) for a Patient’s Implantable Device(s) and Vital Signs. This API conforms to the R4 FHIR standard. The API returns a bulk data file.

  • Read
    https://api.upmchp.com/FHIR/R4/{resourceType}/{resourceId}
  • Search
    https://api.upmchp.com/FHIR/R4/{resourceType}?