Test Sandbox APIs
API Reference
Capability Statement
Explanation of Benefits
The Explanation of Benefit (EOB) API enables Humana members to share written explanation of benefits with third party applications. Explanation of benefits include the payments Humana has made on behalf of a member and a description of the healthcare services provided to the member. This API conforms to the R4 FHIR standard and the CARIN Blue Button FHIR STU1 Implementation Guide.
URL
Headers
| ACCEPT | application/json |
| AUTHORIZATION | Bearer {ACCESS_TOKEN} |
Sample Request
curl -X GET \
https://sandbox-fhir.humana.com/api/ExplanationOfBenefit \
-H 'Accept: application/json' \
-H 'Authorization: Bearer {your access token}' \curl -X GET \
https://fhir.humana.com/api/ExplanationOfBenefit \
-H 'Accept: application/json' \
-H 'Authorization: Bearer {your access token}' \Sample Response
{
"resourceType": "Bundle",
"type": "searchset",
"timestamp": "2025-01-15T05:16:02.635+00:00",
"meta": {
"lastUpdated": "2025-01-15T05:16:02.635+00:00",
"versionId": "edc04c4b-ea57-4313-94ef-bf44b138301b"
},
"entry": [
{
"fullUrl": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit/15ff71886c0732526d758d87857f739868ef8a3259319128b993c9364f51b82f",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "15ff71886c0732526d758d87857f739868ef8a3259319128b993c9364f51b82f",
"meta": {
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"versionId": "1afcf532-dd09-42a2-a7ee-d49ef6c4e8e7",
"lastUpdated": "2025-01-15T03:56:46.371+00:00"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code": "uc"
}
]
},
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "244956709341"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
}
],
"text": "Pharmacy"
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"billablePeriod": {
"start": "2024-04-04"
},
"created": "2024-04-04",
"insurer": {
"reference": "Organization/67c29814ee1eb20b1be2c2c692cfdd2cfb84e919a867998eccd1762b7b785780",
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1841422979"
},
"display": "SHILPA ARUN MALEKAR"
},
"prescription": {
"identifier": {
"system": "http://hl7.org/fhir/sid/ndc",
"value": "00006027782"
},
"display": "Januvia 100 mg tablet"
},
"payee": {
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/payeetype",
"code": "provider",
"display": "Provider"
}
]
},
"party": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1063675684"
},
"display": "HUMANA PHARMACY, INC."
}
},
"facility": {
"display": "9843 WINDISCH ROAD, WEST CHESTER, OH, 45069"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H71498680"
}
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "000665036",
"display": "Januvia 100 mg tablet"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "00006027782",
"display": "Januvia 100 mg tablet"
}
]
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 2062.8,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidbypatient"
}
],
"text": "Paid by patient"
},
"amount": {
"value": 1654.54,
"currency": "USD"
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "CoPay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 1654.84,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "PAID"
}
]
},
"date": "2024-04-04",
"amount": {
"value": 1654.84,
"currency": "USD"
}
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit/b587139d9106c33f1c2648b8df295e4b9d9f98b03738b98f64e904df3f02165b",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "b587139d9106c33f1c2648b8df295e4b9d9f98b03738b98f64e904df3f02165b",
"meta": {
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"versionId": "65deee4b-eb60-4184-a05f-f95be8e949fc",
"lastUpdated": "2025-01-15T03:56:46.980+00:00"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code": "uc"
}
]
},
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "244956707751"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
}
],
"text": "Pharmacy"
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"billablePeriod": {
"start": "2024-04-04"
},
"created": "2024-04-04",
"insurer": {
"reference": "Organization/67c29814ee1eb20b1be2c2c692cfdd2cfb84e919a867998eccd1762b7b785780",
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "12121212"
},
"display": "eee ee ggg"
},
"prescription": {
"identifier": {
"system": "http://hl7.org/fhir/sid/ndc",
"value": "64980027903"
},
"display": "glipizide ER 2.5 mg tablet, extended release 24 hr"
},
"payee": {
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/payeetype",
"code": "provider",
"display": "Provider"
}
]
},
"party": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1063675684"
},
"display": "HUMANA PHARMACY, INC."
}
},
"facility": {
"display": "9843 WINDISCH ROAD, WEST CHESTER, OH, 45069"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H714922230"
}
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "000310489",
"display": "glipizide ER 2.5 mg tablet, extended release 24 hr"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "64980027903",
"display": "glipizide ER 2.5 mg tablet, extended release 24 hr"
}
]
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 73.8,
"currency": "USD"
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "CoPay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 0,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "PAID"
}
]
},
"date": "2024-04-04",
"amount": {
"value": 0,
"currency": "USD"
}
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit/325851594eecde9794cff556d61165f8a6b6d61b1762d5bd21e64d2b5e4324e5",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "325851594eecde9794cff556d61165f8a6b6d61b1762d5bd21e64d2b5e4324e5",
"meta": {
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"versionId": "4234568d-1ae8-475c-ae77-d40132b37810",
"lastUpdated": "2025-01-15T03:56:47.320+00:00"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code": "uc"
}
]
},
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "445722757222"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
}
],
"text": "Pharmacy"
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"billablePeriod": {
"start": "2024-06-20"
},
"created": "2024-06-20",
"insurer": {
"reference": "Organization/67c29814ee1eb20b1be2c2c692cfdd2cfb84e919a867998eccd1762b7b785780",
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1841422979"
},
"display": "SHILPA ARUN MALEKAR"
},
"prescription": {
"identifier": {
"system": "http://hl7.org/fhir/sid/ndc",
"value": "81603062510"
},
"display": "DropSafe Alcohol Prep Pads"
},
"payee": {
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/payeetype",
"code": "provider",
"display": "Provider"
}
]
},
"party": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1063675333"
},
"display": "HUMANA PHARMACY, INC."
}
},
"facility": {
"display": "9843 WINDISCH ROAD, WEST CHESTER, OH, 45069"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H71433680"
}
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "000797544",
"display": "DropSafe Alcohol Prep Pads"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "81603062533",
"display": "DropSafe Alcohol Prep Pads"
}
]
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 5,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidbypatient"
}
],
"text": "Paid by patient"
},
"amount": {
"value": 1.32,
"currency": "USD"
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "CoPay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 1.62,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "PAID"
}
]
},
"date": "2024-06-20",
"amount": {
"value": 1.62,
"currency": "USD"
}
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit/f9f0c0599f7ccc173a610d6d381d148e83a9875e3dc84d7d948220c034401af3",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "f9f0c0599f7ccc173a610d6d381d148e83a9875e3dc84d7d948220c034401af3",
"meta": {
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"versionId": "8e3217fe-cf58-495d-94d9-2fa42f5f4cf1",
"lastUpdated": "2025-01-15T03:56:47.624+00:00"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code": "uc"
}
]
},
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "445722755911"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
}
],
"text": "Pharmacy"
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"billablePeriod": {
"start": "2024-06-20"
},
"created": "2024-06-20",
"insurer": {
"reference": "Organization/67c29814ee1eb20b1be2c2c692cfdd2cfb84e919a867998eccd1762b7b785780",
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1841422979"
},
"display": "SHILPA ARUN MALEKAR"
},
"prescription": {
"identifier": {
"system": "http://hl7.org/fhir/sid/ndc",
"value": "56151146404"
},
"display": "True Metrix Glucose Test Strip"
},
"payee": {
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/payeetype",
"code": "provider",
"display": "Provider"
}
]
},
"party": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1063675684"
},
"display": "HUMANA PHARMACY, INC."
}
},
"facility": {
"display": "9843 WINDISCH ROAD, WEST CHESTER, OH, 45069"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H71498222"
}
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "000000000",
"display": "True Metrix Glucose Test Strip"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "56151146404",
"display": "True Metrix Glucose Test Strip"
}
]
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 63,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidbypatient"
}
],
"text": "Paid by patient"
},
"amount": {
"value": 16.64,
"currency": "USD"
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "CoPay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 17.8,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "PAID"
}
]
},
"date": "2024-06-20",
"amount": {
"value": 17.8,
"currency": "USD"
}
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit/74ea9c5b19d20b327db229c25c4c2ea18914f679c1a46b97b4cb88b9a7a667f5",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "74ea9c5b19d20b327db229c25c4c2ea18914f679c1a46b97b4cb88b9a7a667f5",
"meta": {
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"versionId": "3f2f9645-c110-4e97-8c0c-0f88fd1bb813",
"lastUpdated": "2025-01-15T03:56:47.771+00:00"
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