Independence Blue Cross Claims & Explanation Of Benefit

naftiko: 1.0.0-alpha2
info:
  label: Independence Blue Cross Claims & Explanation Of Benefit
  description: >-
    Naftiko capability surfacing claims-adjacent FHIR R4 resources from
    the Independence Blue Cross Patient Access API: Coverage,
    ExplanationOfBenefit, and MedicationRequest. Modeled against the
    CARIN for Blue Button (CARIN BB) and CPCDS profiles. Read-only;
    requires a SMART on FHIR bearer token bound to a single member
    context.
  tags:
    - Independence Blue Cross
    - Claims
    - Explanation Of Benefit
    - CARIN Blue Button
    - FHIR
    - SMART On FHIR
  created: '2026-05-23'
  modified: '2026-05-23'
binds:
  - namespace: env
    keys:
      IBX_PATIENT_BEARER_TOKEN: IBX_PATIENT_BEARER_TOKEN
capability:
  consumes:
    - type: http
      namespace: ibx-claims
      baseUri: https://eapics.ibx.com/patient/v1/fhir
      description: >-
        Independence Blue Cross Patient Access FHIR R4 endpoint, used
        for claims/EOB-adjacent queries. Shares the same SMART on FHIR
        access token used for clinical Patient Access calls.
      resources:
        - name: Coverage
          path: /Coverage
          operations:
            - name: searchCoverage
              method: GET
              description: Search Coverage records for a member (CARIN BB Coverage profile)
              outputRawFormat: json
              inputParameters:
                - name: patient
                  in: query
                  type: string
                  required: true
              outputParameters:
                - name: result
                  type: object
                  value: $.
        - name: ExplanationOfBenefit
          path: /ExplanationOfBenefit
          operations:
            - name: searchExplanationOfBenefit
              method: GET
              description: Search ExplanationOfBenefit (claims) for a member; supports CARIN BB inpatient, outpatient, pharmacy, and oral profiles
              outputRawFormat: json
              inputParameters:
                - name: patient
                  in: query
                  type: string
                  required: true
                - name: service-date
                  in: query
                  type: string
                  required: false
                - name: type
                  in: query
                  type: string
                  required: false
              outputParameters:
                - name: result
                  type: object
                  value: $.
            - name: readExplanationOfBenefit
              method: GET
              path: /ExplanationOfBenefit/{id}
              description: Read a single ExplanationOfBenefit by id
              outputRawFormat: json
              inputParameters:
                - name: id
                  in: path
                  type: string
                  required: true
              outputParameters:
                - name: result
                  type: object
                  value: $.
        - name: MedicationRequest
          path: /MedicationRequest
          operations:
            - name: searchMedicationRequest
              method: GET
              description: Search MedicationRequest resources for a member
              outputRawFormat: json
              inputParameters:
                - name: patient
                  in: query
                  type: string
                  required: true
              outputParameters:
                - name: result
                  type: object
                  value: $.
      authentication:
        type: bearer
        token: '{{env.IBX_PATIENT_BEARER_TOKEN}}'
  exposes:
    - type: rest
      namespace: ibx-claims-rest
      port: 8081
      description: REST adapter exposing CARIN BB EOB and Coverage as conventional REST resources.
      resources:
        - path: /v1/coverage
          name: coverage
          description: Search member coverage
          operations:
            - method: GET
              name: searchCoverage
              description: Search Coverage
              call: ibx-claims.searchCoverage
              with:
                patient: rest.patient
              outputParameters:
                - type: object
                  mapping: $.
        - path: /v1/eob
          name: eob
          description: Search ExplanationOfBenefit
          operations:
            - method: GET
              name: searchEob
              description: Search EOB
              call: ibx-claims.searchExplanationOfBenefit
              with:
                patient: rest.patient
                service-date: rest.service_date
                type: rest.type
              outputParameters:
                - type: object
                  mapping: $.
        - path: /v1/medication-requests
          name: medication-requests
          description: Search MedicationRequest
          operations:
            - method: GET
              name: searchMedicationRequests
              description: Search MedicationRequest
              call: ibx-claims.searchMedicationRequest
              with:
                patient: rest.patient
              outputParameters:
                - type: object
                  mapping: $.
    - type: mcp
      namespace: ibx-claims-mcp
      port: 9091
      transport: http
      description: MCP adapter exposing CARIN BB / EOB tooling for governed agents. All read-only.
      tools:
        - name: search-coverage
          description: Search Coverage records for a member
          hints:
            readOnly: true
            destructive: false
            idempotent: true
          call: ibx-claims.searchCoverage
          with:
            patient: tools.patient
        - name: search-eob
          description: Search ExplanationOfBenefit (claims) for a member
          hints:
            readOnly: true
            destructive: false
            idempotent: true
          call: ibx-claims.searchExplanationOfBenefit
          with:
            patient: tools.patient
            service-date: tools.service_date
            type: tools.type
        - name: read-eob
          description: Read a single ExplanationOfBenefit by id
          hints:
            readOnly: true
            destructive: false
            idempotent: true
          call: ibx-claims.readExplanationOfBenefit
          with:
            id: tools.id
        - name: search-medication-requests
          description: Search MedicationRequest resources for a member
          hints:
            readOnly: true
            destructive: false
            idempotent: true
          call: ibx-claims.searchMedicationRequest
          with:
            patient: tools.patient