Building Your Own Claims API

Data + Identity = API

1. The Database

  • Has 100%, 24/7 uptime. No monthly maintenance windows or random outages. Your API will likely get called in the middle of the night and on weekends, so your daytime analytics database probably won’t work.
  • Responds to queries for an average medical record in a couple seconds or less. APIs generally need to respond in under ten seconds, so you can’t have your database eating up too much of that time. If your database is well-indexed and designed, this shouldn’t be a problem.
  • Has a well-known, unique identifier that we can match to the identity system in step two. First and last name will be insufficient.
  • Has enough information to represent a patient’s claims history.

2. The Identity Source

  • Confidence that the person signing in is who they say they are. This can mean identity proofing everyone online or creating accounts in person. But it’s worth some extra attention before giving out health information.
  • A unique identifier. At CMS, this meant a HICN or MBI, but you likely have your own system. As long as it uniquely identifies patients and also exists in your database above, you should be fine.
  • An ability to connect to a new system, such as the API you’re building.

3. The API

  • Use JSON and FHIR for your data format.
  • Use OAuth to determine permissions
  • Only give out API keys to companies you’ve spoken to and have some trust in. You’ll never be perfect, but don’t give a key to just anyone, and definitely don’t give it out automatically.
  • Have a public sandbox version of your API with synthetic data.

4. The Community





Software engineer making important things work just a little better, focused on healthcare and government

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Sam Gensburg

Sam Gensburg

Software engineer making important things work just a little better, focused on healthcare and government

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