Welcome to Presbyterian Health Plan Inc. and Presbyterian Insurance Company Inc. Interoperability API Gateway Developer Portal!

Enabling APIs to leverage access to a patient’s clinical and administrative data.

Data APIs available

APIs for interoperability comprised of USCDI clinical data, CARIN administrative data, Da Vinci Formulary Drug data and Da Vinci Provider Directory data

How Do I Start?

The APIs of Presbyterian Health Plan Inc. and Presbyterian Insurance Company Inc. Interoperability Solution provide the basis for building healthcare applications, such as mobile, that deliver HL7® FHIR® data to members and providers on demand. Some example applications use cases could be to view test results, check on medications, and review recent office visits.

Our APIs allow access to clinical, administrative and formulary drug plan information about a patient, as well as provide detailed provider directory information. Applications will securely interact with this data on behalf of the patient in order to deliver patients real-time access to their healthcare data.

Key third party resources and links:

Patient Access API
- United States Core Data for Interoperability (USCDI)
  Definition for the clinical data implementation guide
- Da Vinci Payer Data Exchange US Drug Formulary*
  Definition for Drug Formulary implementation guide
- Consumer Directed Payer Data Exchange (CARIN IG for Blue Button)**
  Definition for administrative data implementation guide
Provider Directory API
- Da Vinci Payer Data Exchange Plan Net Directory*
  Definition for provider directory implementation guide

Example API Endpoint

As an example, you can obtain member profile data based on tenant enrollment ID, subscriber ID and profile group by making an API call to
/profile-fxi-data/get-member-tenantenrollmentid().

On the API page, you can test-execute this operation by clicking the “Try it” link and following the instructions. In this case, you’ll receive an example set of member profile data in the returned response.

GET /member/{tenantenrollmentid}
{
    "type": "object",
    "properties": {
        "tenantEnrollmentId": {
            "type": "string",
            "description": "Unique ID assigned."
        },
        "subscriberId": {
            "type": "string",
            "description": "The subscriber's ID."
        },
        "profileGroups": {
            "$ref": "#/definitions/profileGroups"
        }
    }
}

Explore APIs

About us

Presbyterian Health Plan and Presbyterian Insurance Company offers a full spectrum of health insurance choices to meet the diverse needs of New Mexicans. Today, more than 600,000 New Mexicans are enrolled in either a Presbyterian’s Commercial (individual or employer-sponsored), Medicare Advantage, or Medicaid plan.

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Cognizant Supplemental Terms

*HL7 Da Vinci Project: Da Vinci is a private sector initiative that addresses the needs of the Value Based Care Community by leveraging the HL7 FHIR platform.

**The CARIN alliance: https://www.carinalliance.com/about-us/

HL7® and FHIR® are the registered trademarks of Health Level Seven International and the use does not constitute endorsement by HL7.