Interoperability APIs

Peak Health provides access to application programming interfaces (APIs) and documentation pursuant to the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access Final Rule, CMS-9115-F.  For help in setting up your application to access these APIs, please contact [email protected].

API Documentation

Patient Access APIs – Peak Health will provide, when appropriate and with the necessary authorization from the enrolled member or their personal representative, access to available information such as adjudicated claims, encounter records from capitated providers, formulary details, and relevant clinical data—if such data is maintained by Peak Health.

Provider Directory APIs – This API makes provider, organization, and location information available in a standardized, machine-readable format for third-party applications. It includes details such as addresses, contact information, accessibility indicators, participating networks, and whether providers are accepting new patients. The Provider Directory API is publicly accessible and does not require authentication. Documentation includes endpoint descriptions, field definitions, pagination details, and sample responses to support easy integration.