The CARIN Alliance is a multi-sector group of stakeholders representing numerous hospitals, thousands of physicians, millions of consumers and caregivers, and an HL7 FHIR Accelerator program. We are committed to providing consumers and their authorized caregivers access to health information. Specifically, we are promoting the ability for consumers and their authorized caregivers to gain digital access to their health information via open Application Programming Interfaces (APIs) and the ability to use that information in any third-party application they choose.
CARIN Digital Insurance Card IG
The CARIN Alliance developed the CARIN Digital Insurance Card implementation guide (IG), which provides a set of resources that payers can display to consumers via a Fast Healthcare Interoperability Resources (FHIR) API. The goal of the IG is to enable every provider, payer, and insurance beneficiary in the United States to use a free and open standards-based digital insurance card.
In April 2024, STU 1.1.0 was published with support for SMART Health Cards (SHC) and SMART Health Links (SHL). SHC and SHLs enable individuals to receive their health information and share it with others in a tamper-proof and verifiable digital form. They also provide a digital version of an individual’s clinical information that can be kept at the ready and easily shared with others when the need arises–using a QR code, mobile app or web browser. Together SHC and SHLs provide options that support multiple goals–from keeping a small amount of verifiable medical information close by to authorizing a trusted party to access their entire medical record. They empower individuals with secure, equitable and privacy-preserving access to their clinical information. In 2024, several payers began to explore issuing digital insurance cards based on this specification.
In 2025, CARIN will begin work to add additional capabilities to the IG including updating the IG to the latest version of US Core. We invite you to reach out to Mark Roberts mark.roberts@leavittpartners.com to join the conversation.
We are also excited to announce that the SMART Health Cards and Links FHIR IG went through the September 2024 HL7 Ballot Cycle. We are currently wrapping up the ballot reconciliation process and anticipate publishing the IG soon. The next version of the CARIN Digital Insurance Card IG will point to the published SMART Health Cards and Links FHIR IG.
CARIN Blue Button® IG
The CARIN Consumer Directed Payer Data Exchange Implementation Guide (CARIN IG For Blue Button®) describes the CARIN for Blue Button® Framework and Common Payer Consumer Data Set (CPCDS), providing a set of resources that payers can display to consumers via a FHIR API to meet the CMS requirements related to the Patient Access API. To meet the Interoperability and Prior Authorization Final Rule (CMS-0057) several updates were made to the CARIN IG for Blue Button that we will highlight as they are critical for implementers to understand. In the final rule CMS updated its recommendation to:
- Move from CARIN IG for Blue Button STU 1.1.0 to STU 2.0.0. to meet the requirements of the Patient Access API
- CARIN IG for Blue Button STU 2.0.0 includes dental and vision (vision as part of the professional and non-clinician profile)
- Oral and vision claims information is now required as part of the Patient Access API
- CMS will also require that impacted payers move to US Core IG STU 6.1.0
In 2024, work continued to meet the requirements of the CMS-0057 final rule and publish STU 2.1.0. In February 2025, the STU 2.1.0 version was published and can be found here: https://hl7.org/fhir/us/carin-bb/STU2.1/
Particular changes of note are:
- Added support for US Core 6.1.0, including changed base profile of the Patient, Coverage, Practitioner, Organization, and RelatedPerson to US Core 6.1.0 and added that the IG complies with requirements for US Core 3.1.1
- Non-Financial Profiles (Basis profiles) that enable the sharing of EOB data without the requirement of remittance or other financial information to be used for sharing with individuals who are not the patient or patient representative (e.g. Provider Access API).
See full set of changes here: https://hl7.org/fhir/us/carin-bb/STU2.1/change_notes.html
CARIN Consumer Facing Real Time Pharmacy Benefit Check (RTPBC) IG
Using the RTPBC IG, a patient can learn the cost of, and insurance coverage related to, medications they have been prescribed. In 2024, several states passed or went live with laws that require health plans and insurers to provide comprehensive, real-time prescription drug cost and coverage data to patients and providers through standard APIs.
CARIN held working sessions to discuss what updates might need to be made to the CARIN RTPBC IG to meet these requirements. The consensus was that implementing the current RTPBC IG would fulfill current state requirements.
In the summer of 2025, with support from the NCPDP Foundation, CARIN plans to begin work to update the Implementation Guide to STU 2.0.0 based on member feedback and to synchronize the CARIN RTPBC FHIR API standard with the NCPDP XML RTPB standard. This effort will include launching industry pilots to validate the updates and how these harmonized standards deliver medication cost transparency across provider and consumer ecosystems. Please contact Kim Boyd (kim.boyd@leavittpartners.com) for more information and to join the efforts.
The CARIN Alliance workstreams meet regularly. If you want to engage, don’t hesitate to get in touch with Ryan Howells (ryan.howells@leavittpartners.com) or Mark Roberts (mark.roberts@leavittpartners.com).
