Provider Access · CMS-0057F · 42 CFR 422.121 · PDex STU 2.1.0

Provider Access

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Treating providers pull member clinical and claims data through bulk and resource-level FHIR APIs. Access is scoped to the provider's active attribution list — only members with an active care relationship are accessible. PDex STU 2.1.0.

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Endpoints

Core FHIR operations for the Provider Access API.

GET/Group

List active attribution groups for a treating provider.

GET/Group/{id}/$export

Async bulk FHIR export for a member attribution group.

GET/Patient/{id}/$everything

Single-patient summary for a specific attributed member.

GET/Patient/{id}/Coverage

Active coverage for an attributed member.

Auth scopes

SMART on FHIR system-level scopes for provider access.

Scope	Description	Required
system/Patient.read	Read all attributed patients.	Yes
system/ExplanationOfBenefit.read	Read all EOBs for attributed members.	Yes
system/Coverage.read	Read coverage for attributed members.	Yes
system/*.read	Bulk read for all resource types.	No