Developer resources

Independence Blue Cross machine readable files

Independence Blue Cross is required to make available to the public, machine readable files effective for plan years on and after January 1, 2022. These files will be updated monthly and are meant for use by third-party developers, consultants, government agencies, and employers.

• Enforcement date for in and out-of-network machine readable files is July 1, 2022
• Enforcement date for the pharmacy machine-readable file is delayed pending further rule-making

Machine readable files

• Keystone Health Plan East
• QCC Insurance Company
• BC Hospital Indemnity, Inc.
• Independence Assurance Co, Inc.

These files are not designed for use by members. Members are encouraged to use the care cost estimator tool available on the Independence Blue Cross member website or mobile app. These files are not a guarantee of coverage, nor a guarantee of the reimbursement rate that will be applied for any procedure. The claims reimbursement process is subject to a variety of factors that are not addressed in these files, including eligibility, medical necessity determinations, utilization management requirements, exclusions and other plan terms. These files also do not offer any information on a member's out-of-pocket charges.

Independence Blue Cross Interoperability APIs

Independence Blue Cross (Independence) Interoperability application programming interfaces (“APIs”) enable Independence Medicare Advantage (MA) and Keystone HMO Children’s Health Insurance Program (CHIP) members, or their personal representatives, to consent to share their data with third-party applications. They also allow third-party application owners to connect to provider and pharmacy directories, further referred to as “public non-member specific data.”

Independence Developer Portal

The Independence Developer Portal provides third-party app developers with access to documentation, registration services, Developer Sandbox services, and other developer services related to APIs provided by Independence, pursuant to the Centers for Medicare & Medicaid Services (“CMS”) Interoperability and Patient Access Final Rule (CMS-9115-F).

Our API functionality

The Patient Access API will allow developers to retrieve, with the approval and at the direction of an applicable Independence enrollee or the enrollee’s personal representative, certain data, as applicable, concerning adjudicated claims, encounter data from capitated providers, formulary data, and certain clinical data, if Independence maintains any such data.

The Provider Directory API will allow developers to retrieve, as applicable, certain Independence provider and pharmacy directory information. The Developer Sandbox will allow developers to test their application’s connection to the APIs without establishing production access to the APIs. Independence Interoperability APIs provide the functionalities listed below:

• Enables developers to register their company and its member-facing applications
• Enables members or their personal representatives to shop for mobile and web applications that can utilize healthcare data sourced from the member’s MA and Keystone HMO CHIP plan
• Enables members or their personal representatives to provide consent for an application to access their data
• Uses the HL7 Fast Healthcare Interoperability Resources (FHIR) standard for member data
• Uses the OAuth 2.0/Open ID Connect standard for member authentication and authorization
• Uses the HL7 FHIR standard for sharing public non-member specific data

App developer API support

Explore and test our APIs, view documentation, and more.

Carrier data sets

Separately from the APIs, Independence will allow the following data sets to be downloaded.

Keystone Health Plan East, Inc.

Provider data

• Medical Data
• Dental Data
• Vision Data
• Pharmacy Data

Formulary data

• Formulary Data

Plan data

• Plan Data
• Index File

Independence Blue Cross (QCC Ins. Co.)

Provider data

• Medical Data
• Dental Data
• Vision Data
• Pharmacy Data

Formulary data

• Formulary Data

Plan data

• Plan Data
• Index File

Commercial directories

This directory is updated monthly throughout the year. It is important to know that when you enroll in this plan, covered services are provided through the Independence Blue Cross health care provider network. Independence Blue Cross reserves the right to add or delete participating physicians, hospitals, and/or other health care providers at any time. Independence Blue Cross cannot guarantee the continued participation of any one doctor, hospital, or other health care provider. It is very important that you verify your provider’s network membership before receiving services. For updated or more detailed information regarding participating providers, visit our website at www.ibx.com, or call Customer Service at 1-800-ASK-BLUE (1-800-275-2583) Monday through Friday, 8 a.m. to 6 p.m. TTY/TDD users should call 711.