Claims (Blue Button) Synchronization with Health Cloud and Data Cloud

CMS Blue Button 2.0 is an API that contains four years of Medicare Part A, B, and D data for 65 million Medicare beneficiaries. This data reveals a variety of information about a beneficiary’s health, including the type of Medicare coverage, drug prescriptions, primary care treatment, and cost. Beneficiaries also have full control over how their data can be used and by whom, with identity and authorization controlled by MyMedicare.gov.

This integration empowers healthcare organizations to consolidate patient health data from multiple sources into a single, secure, and user-friendly Salesforce Health Cloud platform. Whether you are a patient, care coordinator, or healthcare provider, CMS Blue Button 2.0 Integration with Salesforce Health Cloud puts you in the driver's seat of your health management. With the Patient’s consent, the API reads their Explanation of Benefit (EOB) records and extracts key clinical and administrative data like Encounters, Procedures, Conditions, and Medication Requests. The data is then stored in the Salesforce Clinical data model. This gives the patients access to important medical encounters that have happened outside their healthcare organization and hence are not present in their Electronic Medical Records.

The financial data like total adjudication amount, out of the pocket expense is extracted and send to Data Cloud. Please check the Ingestion API schema for data cloud that is attached as part of this asset

The Integration can also work with any Payer API that exposes the Explanation of Benefit endpoint for its members in compliance to the CARIN Blue Button Implementation guide.

Providers and payers can deliver more personalized care plans and significantly improve care coordination efforts for patients by having access to the patient's complete health history.

Please find the API specification for usage