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://fhir.humana.com/sandbox/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",
"id": "8091fe437cd7447d96ba3ab8b937bb53",
"meta": {
"lastUpdated": "2021-09-13T12:49:58.903407+00:00"
},
"type": "searchset",
"link": [
{
"relation": "next",
"url": "https://fhir.humana.com/sandbox/api/ExplanationOfBenefit?_count=3&patient=5a357166754b59777137634248494434654c336d68773d3d&ct=W3sidG9rZW4iOiIrUklEOn5RNlpxQU9jemxRdmJtQndBQUFBQUFBPT0jUlQ6MSNUUkM6MyNJU1Y6MiNJRU86NjU1NTEjUUNGOjQjRlBDOkFnSnlBQ1VCY2dBR0FOSVlBRWdDQUFNQkJBQmhJRHdBSlFFRUFLRXdDQUU9IiwicmFuZ2UiOnsibWluIjoiIiwibWF4IjoiRkYifX1d"
},
{
"relation": "self",
"url": "https://fhir.humana.com/sandbox/api/ExplanationOfBenefit?_count=3&patient=5a357166754b59777137634248494434654c336d68773d3d"
}
],
"entry": [
{
"fullUrl": "https://fhir.humana.com/sandbox/api/ExplanationOfBenefit/b1b9c04a9dd63b13c8a9160910ad081223a99b686310b9983aeb96800d5e9879",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "b1b9c04a9dd63b13c8a9160910ad081223a99b686310b9983aeb96800d5e9879",
"meta": {
"versionId": "52",
"lastUpdated": "2021-09-11T08:30:09.203+00:00",
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"tag": [
{
"system": "https://www.hl7.org/fhir/patient.html",
"code": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
{
"system": "https://fhir.humana.com/documentation/glossary/lastRefreshedOn",
"code": "2021-09-11T08:30:08.499Z"
}
]
},
"identifier": [
{
"use": "usual",
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "558840872952"
},
{
"system": "https://fhir.humana.com/documentation/glossary/source_data_id",
"value": "CDF-EobRx-user00001-NTU4ODQwODcyOTUy"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy",
"display": "Pharmacy"
}
],
"text": "Pharmacy"
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"created": "2020-06-11",
"insurer": {
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "5337254169"
},
"display": "Grayce Considine"
},
"prescription": {
"identifier": {
"system": "http://hl7.org/fhir/sid/ndc",
"value": "68968017201"
},
"display": "Secuado"
},
"facility": {
"display": "098 Thompson Ways, Gloriaborough OH, 43603-2615"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H55416971"
},
"display": "Valentine Renner"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "2265729",
"display": "Secuado"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "68968017201",
"display": "Secuado"
}
]
}
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "allowedamount"
}
]
},
"amount": {
"value": 141.67,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "cobamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "coinsuranceamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "copaymentamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "deductibleamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "noncoveredamount"
}
]
},
"amount": {
"value": 142.51,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "patientpayamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "paymentamount"
}
]
},
"amount": {
"value": 141.67,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "paid"
}
]
},
"date": "2020-06-12",
"amount": {
"value": 141.67,
"currency": "USD"
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "https://fhir.humana.com/sandbox/api/ExplanationOfBenefit/497621d008b10d498183e9db5a7fce911adb54e0a118dfc1c8eddfe7f96741a7",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "497621d008b10d498183e9db5a7fce911adb54e0a118dfc1c8eddfe7f96741a7",
"meta": {
"versionId": "52",
"lastUpdated": "2021-09-11T08:30:09.236+00:00",
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"tag": [
{
"system": "https://www.hl7.org/fhir/patient.html",
"code": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
{
"system": "https://fhir.humana.com/documentation/glossary/lastRefreshedOn",
"code": "2021-09-11T08:30:08.499Z"
}
]
},
"identifier": [
{
"use": "usual",
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "005924065830"
},
{
"system": "https://fhir.humana.com/documentation/glossary/source_data_id",
"value": "CDF-EobRx-user00001-MDA1OTI0MDY1ODMw"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy",
"display": "Pharmacy"
}
],
"text": "Pharmacy"
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"created": "2020-06-11",
"insurer": {
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "6740584571"
},
"display": "Annamarie Eichmann"
},
"prescription": {
"identifier": {
"system": "http://hl7.org/fhir/sid/ndc",
"value": "10702023701"
},
"display": "ursodiol"
},
"facility": {
"display": "685 Malika Glens, Kautzermouth VT, 80506-2894"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H29315594"
},
"display": "Valentine Renner"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "858747",
"display": "ursodiol"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "10702023701",
"display": "ursodiol"
}
]
}
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "allowedamount"
}
]
},
"amount": {
"value": 86.86,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "cobamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "coinsuranceamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "copaymentamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "deductibleamount"
}
]
},
"amount": {
"value": 86.86,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "noncoveredamount"
}
]
},
"amount": {
"value": 51.26,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "patientpayamount"
}
]
},
"amount": {
"value": 86.86,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "paymentamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "paid"
}
]
},
"date": "2020-06-12",
"amount": {
"value": 0,
"currency": "USD"
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "https://fhir.humana.com/sandbox/api/ExplanationOfBenefit/15e258206ad202eb2f79cdf17e983a6daf021b14c77feb2b03fe20a49afb8e01",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "15e258206ad202eb2f79cdf17e983a6daf021b14c77feb2b03fe20a49afb8e01",
"meta": {
"versionId": "52",
"lastUpdated": "2021-09-11T08:30:09.267+00:00",
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"tag": [
{
"system": "https://www.hl7.org/fhir/patient.html",
"code": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
{
"system": "https://fhir.humana.com/documentation/glossary/lastRefreshedOn",
"code": "2021-09-11T08:30:08.499Z"
}
]
},
"identifier": [
{
"use": "usual",
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "865727233467"
},
{
"system": "https://fhir.humana.com/documentation/glossary/source_data_id",
"value": "CDF-EobRx-user00001-ODY1NzI3MjMzNDY3"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy",
"display": "Pharmacy"
}
],
"text": "Pharmacy"
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"created": "2020-06-11",
"insurer": {
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "0799824874"
},
"display": "Bo Borer"
},
"prescription": {
"identifier": {
"system": "http://hl7.org/fhir/sid/ndc",
"value": "58468009001"
},
"display": "Synvisc"
},
"facility": {
"display": "5251 Keeling Land, North Murielport AK, 61714-1917"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H38853114"
},
"display": "Valentine Renner"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "1245423",
"display": "Synvisc"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "58468009001",
"display": "Synvisc"
}
]
}
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "allowedamount"
}
]
},
"amount": {
"value": 63.75,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "cobamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "coinsuranceamount"
}
]
},
"amount": {
"value": 12.75,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "copaymentamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "deductibleamount"
}
]
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "noncoveredamount"
}
]
},
"amount": {
"value": 21.84,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "patientpayamount"
}
]
},
"amount": {
"value": 12.75,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-adjudicationcategory",
"code": "paymentamount"
}
]
},
"amount": {
"value": 51,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "paid"
}
]
},
"date": "2020-06-12",
"amount": {
"value": 51,
"currency": "USD"
}
}
},
"search": {
"mode": "match"
}
}
]
}