Review the Da Vinci PDex IG (hl7.org/fhir/us/davinci-pdex) to understand the member access requirements, which layer on CARIN BB EOB profiles and require the payer to expose an ExplanationOfBenefit search endpoint.
Authenticate using SMART on FHIR standalone launch with the appropriate patient-level scopes (patient/ExplanationOfBenefit.read) and receive an access token with the patient context.
Issue a FHIR search request GET [base]/ExplanationOfBenefit?patient=[id] to retrieve all EOB resources for the member and handle Bundle pagination using the next link.
Parse returned EOB resources and determine their type (inpatient institutional, outpatient institutional, professional, pharmacy) from EOB.type coding to apply the correct CARIN BB profile interpretation.
Extract clinical and cost data from EOB.item, EOB.adjudication, and EOB.total slices and present to the member application, surfacing submitted, eligible, and benefit amounts.
Handle the case where the server returns an OperationOutcome or empty Bundle — implement retry logic with backoff and surface appropriate user-facing messages when no EOB data is available.
Known gotchas
PDex member access requires both clinical data (via US Core profiles) and claims data (via CARIN BB EOB profiles) from the same endpoint — clients must be prepared to handle both resource types in search results.
Payers may paginate EOB results with small page sizes (e.g., 10 resources per page) — clients that do not follow Bundle.link next pages will silently miss claim history.
The PDex IG requires the payer to support the $everything operation in addition to individual resource searches; a member app that relies only on resource-type searches may miss resources only returned via $everything.
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp