CARIN Blue Button is an HL7 FHIR implementation guide, developed by the CARIN Alliance, that standardizes how health plans expose a member's claims and encounter data to consumer-directed apps. It defines FHIR profiles for Explanation of Benefit and related resources so a patient can direct their payer data to an app of their choice. It underpins the CMS Blue Button 2.0 API and the payer Patient Access APIs mandated by CMS.
CARIN Blue Button
CARIN Blue Button is the standard that lets a patient point their claims data — not their clinical chart, but the record of what was billed and paid — at an app they choose. It is the payer-side complement to clinical FHIR, and the machine-readable expression of a consumer’s right to their own coverage data.
- Claims as FHIR - Standard profiles for Explanation of Benefit and supporting resources turn opaque payer data into structured, portable records.
- Consumer-directed - The whole point is patient direction: the member authorizes the data to flow, echoing the patient-directed-API idea at the coverage layer.
- The base for CMS Patient Access - CMS Blue Button 2.0 and the payer Patient Access APIs run on it.
CARIN Blue Button is a good example of a standard doing the quiet, correct thing — making a legal right (access to your claims) into a live, machine-readable capability. In my scoring it sits behind the payer/claims layer, and like the rest of US healthcare FHIR, its weak point is not the schema but the missing consent legibility and examples that would let an agent actually shop and reason over coverage on a patient’s behalf.
Referenced in API Evangelist papers
This standard shows up in my published research. These reports read the machine-readable evidence provider by provider — and put this standard in the context of a real sector.
The State of US Healthcare APIs
The consumer-directed claims layer beneath CMS Blue Button 2.0 and payer Patient Access APIs.
Governed by these regulations
A standard is the machine-readable contract; a regulation is the law that requires it. These are the regulations that mandate or drive this standard, catalogued at regulations.apievangelist.com.
CMS Interoperability & Prior Authorization Rule
CMS Patient Access APIs use CARIN Blue Button to expose claims and encounter data to members.
