Getting Started
Our API developer program ensures quality and security to your healthcare development work. Requesting access is easy. For your reference, you can download the Interoperability API Endpoint Support Document. This document outlines all API endpoints available for connections and their access details.
Our Current APIs
Before you get started, learn about our current service APIs. Note: The Patient Access API requires that you first fill out our developer registration form.
Patient Access API
The Patient Access API enables Anthem members to securely access and exchange their medical, pharmacy, dental, and vision claims and clinical data. This API will allow an individual to export up to 5 years of historical information.
This RESTful API conforms to the R4 FHIR standard, SMART on FHIR, and CARIN Blue Button version STU1(1.0).
Formulary API
The Formulary API provides data on formularies associated with different insurance plans provided by certain Anthem-affiliated Medicare, Medicaid, and CHIP health plans, and the corresponding drug lists. Data on cost sharing for the drugs under a formulary and their respective tier and pharmacy type data is also available through the API.
Our implementation follows DaVinci Payer Data Exchange (PDex) US Drug Formulary IG and we have implemented the STU2 sequence Release 2.0.0.
Provider Directory API
Anthem offers a Provider Directory service that enables current or prospective members to see which providers are in-network for a given Anthem insurance plan. This service includes multiple FHIR APIs: InsurancePlan, Practitioner, PractitionerRole, Organization, and Location. These APIs follow the HL7 R4 FHIR specification, as well as the DaVinci PDEX Plan Net Implementation Guide.
How our Developer Portal works
Browse the API documentation: Use the API Documentation to better understand how to integrate healthcare data with your application.
Register as a developer to use the Sandbox: Gain quick access to the API Sandbox environment for testing with synthetic data.
Apply for Production credentials: Apply for access to Production APIs. This process can take several weeks, depending on the API.
Deploy your application to Production: Once your application is in Production, visit our Developer Portal often for the latest API release notes.
Registering and Accessing
Developers will need to register with us to access our Patient Access API Sandbox environment or to connect with our Patient Access Production API. Fill out the registration request form, and a representative will contact you shortly.
Benefits of our Developer Portal
API documentation is now available to help you get consistent and reliable data for your applications. APIs are updated frequently as information changes to provide the most up-to-date resources for your application. Check back for what’s new and sign up for notification updates.
Frequently asked questions (FAQs)
Our most frequently asked questions can help you on your healthcare developer path.
Software developers, data scientists, and product team stakeholders in the healthcare industry can all benefit from using the Anthem Developer Portal. Our API documentation is now available to help developers get consistent and reliable data for their application development. APIs are updated frequently as information changes to provide the most up-to-date resources for your application. Be sure to check back for the latest information.
The HL7® FHIR® is the standard for the electronic exchange of healthcare information created by the nonprofit Health Level 7 International (HL7). According to the HL7 website, “FHIR aims to simplify implementation without sacrificing information integrity. It leverages existing logical and theoretical models to provide a consistent, easy to implement, and rigorous mechanism for exchanging data between healthcare applications.”
The CMS Interoperability and Patient Access final rule (CMS-9115-F) “places new requirements on Medicaid and CHIP managed care plans, state Medicaid and CHIP fee-for-service programs, and Qualified Health Plans (QHP) issuers on the Federally-Facilitated Exchanges (FFEs) to improve the electronic exchange of health care data, and streamline processes related to prior authorization.”
This requires all participating organizations and programs to increase patient access to electronic medical information and improve data exchange between patients, providers, and payers. For more information on the parameters of this ruling, please visit the CMS website.
You can download the Interoperability API Endpoint Support Documentation for access.
All lines of business, including the following have access to the Patient Access API: Medicaid and CHIP managed care plans; state Medicaid and CHIP fee-for-service programs; Qualified Health Plans (QHP) issuers on the Federally-Facilitated Exchanges (FFEs); and commercial plans.
Complete the registration request form.
Applications will connect to the Patient Access API production environment using the SMART protocol, which requires registering the redirect URL; your application will use this to connect with the Anthem API.
Contact Us
If you need help with our APIs or want to share feedback,
email our Interoperability Workgroup.