Interoperability & Patient Access Rule

On May 1, 2020, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), issued a rule to improve secure, authorized access to health and insurance data.

Sharing of this information empowers our members with access to their health and insurance information through whatever device or app they choose, allowing caregivers and insurance carriers to work together to best serve our member’s healthcare needs.

Connecting multiple health record sources
In spite of advances in health care technology, including electronic records, there is not an easy or readily available process to connect multiple health care organizations (i.e. doctors, hospitals, clinics, health insurers, and pharmacies.) These new measures will open doors for options to enable health information systems to work together to deliver health care information for patients that can help ensure effective delivery of the best and most affordable care.

Improving health care
5 key benefits of achieving interoperability (Becker’s Health IT) include:

  • Improved care coordination and patient experiences
  • Greater patient safety
  • Stronger privacy and security for patients 
  • Higher productivity and reduced healthcare costs
  • More accurate public health data

How Sanford Health Plan is collaborating for interoperability
Sanford Health Plan has been working to ensure the links and required data, or application-programming interfaces (API) are available to application developers who create apps to support this effort for members. Watch for more information in the future on these new options, and how they can benefit you as a Sanford Health Plan member.

Beneficiary Education Notice

Patient Access API Developer Information

Epic Systems Corporation maintains and supports Sanford Health Plan’s Patient Access API, which are designed to provide secure and efficient access to health data while maintaining the highest standard of data protection. Access is subject to routine monitoring and testing to ensure security and compliance with HIPAA and other relevant regulations. For more details, see our Beneficiary Education Notice.

As part of Sanford Health Plan’s commitment to transparency and accessibility, comprehensive documentation for our APIs is freely accessible to the public at, which includes detailed information on:

  1. API Syntax and Functionality: Complete descriptions of API functions, required and optional parameters, and their data types, as well as return variables and their structures. 
  2. Integration Requirements: Information on the software components and configurations necessary for successful API interaction.
  3. Technical Specifications: All necessary technical requirements and attributes for application registration with our authorization servers.

As mandated by the U.S. Centers for Medicare & Medicaid Services (CMS), the Patient Access API meets the specification as outlined in the CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button) Implementation Guide and the DaVinci Payer Data Exchange (PDex) US Drug Formulary Implementation Guide and conforms to the technical standards for data exchange via secure API. Please reference these sites for more information or contact Epic Systems Corporation as Sanford Health Plan does not support developer-specific questions.


Interoperability links to Sanford Health Plan data

  • Provider Directory API – Contains Sanford Health Plan provider directory information.
  • Patient Access API – Secure sharing of claims data maintained by Sanford Health Plan. Used in conjunction with Sanford Health clinical data (if available), this information can offer a broader and more holistic understanding of an individual’s interactions with the healthcare system, leading to better decision-making and better health outcomes.   
  • Medicare Advantage Formulary API – Drug Formulary service that enables members to see which medications are covered by their Medicare Advantage plan.