Consumer-Directed Payer Data Exchange
- Release 0.1.0

Consumer-Directed Payer Data Exchange, published by CARIN Alliance. This is not an authorized publication; it is the continuous build for version 0.1.0). This version is based on the current content of and changes regularly. See the Directory of published versions

Use Case

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Consumer-directed health insurance data exchange Consumer-directed exchange occurs when a consumer or an authorized caregiver invokes their HIPAA Individual Right of Access (45 CFR 164.524) and requests their digital health information from a HIPAA covered entity (CE) via an application or other third-party data steward.

Use Case: Consumer Access to their Claims Data


  • Consumer (aka Beneficiary, Patient, or Authorized Caregiver)
  • Consumer App- A digital third-party application selected by and primarily for the Consumer with a consumer-facing user interface
  • Patient Portal / Identity Provider
  • Health Plan API (aka Health Plan, Commercial Payer, Covered Entity)

Normal Flow:

  • Consumer downloads or accesses the application of their choice
  • Consumer authorizes the application to access their digital claims data (thereby invoking their Individual Right of Access under HIPAA) via the SMART on FHIR authorization flow
  • Application connects to a FHIR API to download their digital claims data and requests the health plan send the data to the application
  • Application displays or otherwise uses digital claims data to the benefit of the Consumer

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