AmeriHealth Caritas
AmeriHealth Caritas is one of the largest Medicaid managed care organizations in the United States, serving roughly five million members across Medicaid, Children's Health Insurance Program (CHIP), dual-eligible Medicare-Medicaid (D-SNP), Medicare-Medicaid LTSS, and Marketplace lines of business across thirteen states plus the District of Columbia. The company is owned jointly by Independence Blue Cross (majority) and Blue Cross Blue Shield of Michigan, operates state health plans under brands such as Keystone First, Select Health of South Carolina, Blue Cross Complete of Michigan, AmeriHealth Caritas Next, AmeriHealth Caritas VIP Care, and PerformCare, and exposes a set of HL7 FHIR R4 APIs through its developer portal at developer.amerihealthcaritas.com to satisfy the CMS Interoperability and Patient Access final rule (CMS-9115-F).
Real signal across most facets with visible, nameable gaps — the contract exists but is thin, or the portal is good while governance and commercial terms are absent.
API Evangelist profiles AmeriHealth Caritas the way a machine reads it — 78 machine-readable artifacts across 25 APIs, pulled from the provider's own public surface and indexed so a developer, an analyst, or an AI agent can evaluate it against every other provider on the network.
Every provider in the network is reduced to the same set of machine-readable artifacts — OpenAPI contracts, event specifications, GraphQL schemas, runnable collections, pricing and rate-limit signals, security posture, OAuth scopes, and the agent surfaces (MCP servers and skills) that let software drive the API on its own. We profile them because the interface is the part of a company you can actually inspect: it is a truer signal of what a provider does than any marketing page. From those artifacts we compute the Kin Score — AmeriHealth Caritas scores 51.7/100 (developing), with a separate agent-readiness read of 48/100 (agent ready). The full breakdown is below, followed by every artifact we hold — each card links through to its machine-readable definition on apis.io.
Kin Score
This is the API Evangelist rating — a single, repeatable read computed from the artifacts on this page. Green fill is points earned; the red track is points possible, so every bar shows earned-versus-possible at a glance.
Kin Score
How this is scored →scored 2026-07-27 · rubric v0.5
How we profile AmeriHealth Caritas
Each block below is one kind of artifact we hold for AmeriHealth Caritas. For each we say what it is and why it earns a place in the profile, then list every one we've indexed — capped at two rows, scroll within the panel for the rest.
APIs 25
Each API is captured as its own OpenAPI definition — every operation, parameter, and response. This is the single most useful machine-readable description of what an API does, and it's what lets us score, lint, mock, and generate against it without asking the provider for anything.
Individual APIs this provider publishes, each with its own machine-readable definition.
AmeriHealth Caritas Formulary FHIR API
HL7 FHIR R4 Formulary API published to satisfy CMS-9115-F drug formulary publication requirements for Medicaid managed care and D-SNP populations. Covered drug lists, tier infor...
AmeriHealth Caritas Corporate Website
Public corporate website for AmeriHealth Caritas, hosting the family-of-plans health plan finder, solutions overview, careers, member and provider portals for the federated stat...
AmeriHealth Caritas AllergyIntolerance API
The AllergyIntolerance FHIR resource type
AmeriHealth Caritas Claim API
The Claim FHIR resource type
AmeriHealth Caritas Condition API
The Condition FHIR resource type
AmeriHealth Caritas Coverage API
The Coverage FHIR resource type
AmeriHealth Caritas Encounter API
The Encounter FHIR resource type
AmeriHealth Caritas ExplanationOfBenefit API
The ExplanationOfBenefit FHIR resource type
AmeriHealth Caritas HealthcareService API
The HealthcareService FHIR resource type
AmeriHealth Caritas Immunization API
The Immunization FHIR resource type
AmeriHealth Caritas InsurancePlan API
The InsurancePlan FHIR resource type
AmeriHealth Caritas List API
The List FHIR resource type
AmeriHealth Caritas Location API
The Location FHIR resource type
AmeriHealth Caritas Medication API
The Medication FHIR resource type
AmeriHealth Caritas MedicationDispense API
The MedicationDispense FHIR resource type
AmeriHealth Caritas MedicationKnowledge API
The MedicationKnowledge FHIR resource type
AmeriHealth Caritas MedicationRequest API
The MedicationRequest FHIR resource type
AmeriHealth Caritas Observation API
The Observation FHIR resource type
AmeriHealth Caritas Organization API
The Organization FHIR resource type
AmeriHealth Caritas OrganizationAffiliation API
The OrganizationAffiliation FHIR resource type
AmeriHealth Caritas Patient API
The Patient FHIR resource type
AmeriHealth Caritas Practitioner API
The Practitioner FHIR resource type
AmeriHealth Caritas PractitionerRole API
The PractitionerRole FHIR resource type
AmeriHealth Caritas Procedure API
The Procedure FHIR resource type
AmeriHealth Caritas System Level Operations API
Server-level operations
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Open Collections 2
Open, tool-agnostic collections carry the same runnable value as Postman without locking you to one client — the portable, forkable form of the same exercise.
Open, tool-agnostic API collections (OpenAPI-derived and Bruno).
AmeriHealth Caritas
OPEN COLLECTIONAmeriHealth Caritas
OPEN COLLECTIONPricing Plans 1
Pricing is part of the interface. Machine-readable plans tell you what a tier costs and includes before you commit — one of the six things the Kin Score reads for commercial clarity.
Published pricing tiers and plan structures.
Rate Limits 1
Rate limits are the difference between a demo that works and a production integration that doesn't fall over. Publishing them is an operational-transparency signal — and a hard requirement for any agent that plans its own throughput.
Documented rate limits and quota policies.
Amerihealth Caritas Rate Limits
RATE LIMITSFinOps 1
Cost, billing, and metering signals let a buyer model the financial operations of an API before it's live. We profile them for the same reason we profile pricing: the money is part of the contract.
Cost, billing, and metering signals for API financial operations.
Features 8
The notable capabilities this provider advertises, captured as structured features so they can be searched and compared instead of read one landing page at a time.
Notable capabilities this provider offers.
HL7 FHIR R4 Patient Access API
SMART on FHIR / OAuth 2.0 secured member access to AllergyIntolerance, Claim, Condition, Coverage, Encounter, ExplanationOfBenefit, HealthcareService, Immunization, InsurancePla...
HL7 FHIR R4 Provider Directory API
Public, unauthenticated FHIR Provider Directory exposing Practitioner, PractitionerRole, Organization, OrganizationAffiliation, Location, and InsurancePlan resources for member,...
HL7 FHIR R4 Drug Formulary API
CMS-mandated public Drug Formulary surface for AmeriHealth Caritas managed Medicaid and dual-eligible plans, exposed via FHIR MedicationKnowledge and List resources.
Per-Plan FHIR Endpoint Routing
FHIR base URLs are routed per state plan using a four-digit plan code (for example 0100, 0500, 0900, 1200, 2100, 2400, 2600) on api-ext.amerihealthcaritas.com so each Medicaid /...
SMART App Launch 1.0.0 OAuth 2.0
Standard authorization code and PKCE authorization code flows backed by token, authorize, introspect, revoke, and session management endpoints under fhir.amerihealthcaritas.com.
CARIN Blue Button & Da Vinci PDex Conformance
Implementation aligns with the CARIN Blue Button Implementation Guide and the Da Vinci Payer Data Exchange (PDex) IG referenced from the developer portal best-practices section.
USCDI Data Coverage
Data elements published map to the United States Core Data for Interoperability (USCDI v1) to support clinical data exchange to consumer apps.
Developer Portal Self-Service
Developers register, attest, and receive Client ID and Client Secret credentials from developer.amerihealthcaritas.com; once approved, sandbox patient credentials are issued for...
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Semantic Vocabularies 1
JSON-LD contexts give the data shared meaning across APIs. We profile them because semantics are what let a machine reconcile 'customer' here with 'customer' somewhere else.
JSON-LD contexts and semantic vocabularies used across these APIs.
Amerihealth Caritas Context
JSON-LDSpectral Rules 2
Governance rulesets we run against this provider's specs — the automated checks behind parts of the score. Profiling them makes the quality bar explicit and re-runnable, not a matter of opinion.
AmeriHealth Caritas API Rules
SPECTRALAmeriHealth Caritas API Rules
SPECTRALJSON Schema 6
Standalone JSON Schema definitions describe the data models behind the API. We profile them so the shapes are validatable on their own — useful long after a single request is forgotten.
Standalone JSON Schema definitions for this provider's data models.
AmeriHealthCaritasCoverage
JSON SCHEMAAmeriHealthCaritasExplanationOfBenefit
JSON SCHEMAAmeriHealthCaritasLocation
JSON SCHEMAAmeriHealthCaritasOrganization
JSON SCHEMAAmeriHealthCaritasPatient
JSON SCHEMAAmeriHealthCaritasPractitioner
JSON SCHEMAJSON Structure 1
JSON Structure captures the data shapes in a form built for tooling — a complement to JSON Schema that keeps the model machine-legible.
JSON Structure definitions describing this provider's data shapes.
Amerihealth Caritas Health Plan Structure
JSON STRUCTUREExamples 6
Real request and response payloads are what turn a spec from abstract into obvious — and they're one of the twelve things an agent needs to call an API correctly on the first try.
Example request and response payloads for these APIs.
Security Posture 2
Authentication, domain security, vulnerability disclosure, and trust-center signals — the evidence that a provider takes security seriously enough to document it. We profile it because you can't govern what you can't see.
Authentication, domain security, vulnerability disclosure, and trust-center signals.
Agentic Access 1
An x-agentic-access contract marks which operations are safe for an agent to run on its own and which need a human in the loop. It is the difference between an API an agent can use and one it can use safely.
Recommended x-agentic-access execution contracts for AI agents.
Use Cases 6
What developers actually build with this provider — captured so the catalogue answers 'what is this for', not just 'what does this expose'.
What developers build with this provider.
Member Health Record Aggregation
Third-party consumer apps allow Medicaid, D-SNP, and Marketplace members to download and aggregate claims, encounters, medications, immunizations, and care plan data from AmeriH...
Provider Directory Lookups
Care navigation apps, broker tools, and benefits portals query the public Provider Directory FHIR API to find AmeriHealth-Caritas-contracted Practitioners, PractitionerRoles, Or...
Drug Formulary Browsing
Members and prescribers query the public Drug Formulary FHIR API to confirm whether a medication is covered, the tier, and any prior authorization requirements before filling.
Care Coordination Across Dual-Eligible Plans
D-SNP / dual-eligible care managers reconcile Medicare and Medicaid coverage, ExplanationOfBenefit, and Encounter data to coordinate Long-Term Services and Supports (LTSS) and b...
Payer-To-Payer Data Sharing
When a member switches plans, the Patient Access surface can inform payer-to-payer exchange workflows aligned with Da Vinci PDex to migrate clinical history.
Population Health Reporting
State Medicaid agencies and quality reporting partners consume aggregated, member-authorized FHIR data to support HEDIS, quality measure, and SDOH reporting.
Integrations 7
Pre-built integrations with other platforms tell you where this provider already fits in a stack.
Pre-built integrations with other platforms and tools.
Independence Blue Cross
AmeriHealth Caritas is majority-owned by Independence Blue Cross (Philadelphia) and shares brand and operational relationships with the Independence family.
Blue Cross Blue Shield of Michigan
Blue Cross Blue Shield of Michigan is a co-owner of AmeriHealth Caritas and the joint sponsor of Blue Cross Complete of Michigan, the Michigan Medicaid managed care plan operate...
CMS Interoperability Framework
APIs exist to satisfy the CMS-9115-F Interoperability and Patient Access final rule for Medicaid managed care, CHIP, and D-SNP populations.
HL7 FHIR R4
All three APIs implement HL7 FHIR 4.0.1 with SMART App Launch 1.0.0 security, CARIN Blue Button, and Da Vinci PDex guidance.
USCDI v1
Patient Access data set is profiled against USCDI v1 elements for clinical, encounter, medication, and care team data.
SMART on FHIR / OAuth 2.0 / OIDC / PKCE
Standard SMART App Launch authorization code flow and PKCE flow back the Patient Access security model.
State Medicaid Agencies
Each AmeriHealth Caritas state plan operates under contract with a state Medicaid agency (PA DHS, LA LDH, NC DHHS, OH ODM, FL AHCA, NH DHHS, MI MDHHS, DE DHSS, SC DHHS, NJ DHS).
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Solutions 8
Packaged solutions the provider offers on top of the raw API surface.
Packaged solutions this provider offers.
Medicaid Managed Care
Full-risk Medicaid managed care plans operated for state Medicaid agencies in PA, DE, DC, NC, NH, OH, LA, FL, MI, and SC under brands including AmeriHealth Caritas Pennsylvania,...
Dual-Eligible Special Needs Plans (D-SNP)
AmeriHealth Caritas VIP Care, Keystone First VIP Choice, and First Choice VIP Care D-SNP plans serve members eligible for both Medicare and Medicaid across multiple states.
Long-Term Services and Supports (LTSS)
Community HealthChoices plans (AmeriHealth Caritas Pennsylvania Community HealthChoices, Keystone First Community HealthChoices) deliver LTSS-managed care to dual eligibles and ...
Children's Health Insurance Program (CHIP)
Keystone First CHIP and other CHIP plans provide state-administered coverage for children in eligible families.
Individual & Family Marketplace
AmeriHealth Caritas Next and First Choice Next plans on state-based and federal Marketplaces in DE, FL, LA, NC, and SC.
Behavioral Health
PerformCare (Pennsylvania) and PerformCare New Jersey deliver behavioral health managed care and contracted services for state and county programs.
Pharmacy Benefits Management
PerformRx, a wholly-owned pharmacy benefits manager, administers pharmacy benefits for AmeriHealth Caritas plans and external clients.
Third-Party Administration
AmeriHealth Administrators provides third-party administration services for self-funded employer health plans.
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Resources
Every other property we hold for AmeriHealth Caritas — documentation, portals, status pages, policies, and corporate surface — grouped by the job it does, following the integrator's arc from getting started to running in production.
Get Started 2
Portal, sign-up, and the first successful call
Documentation 1
Reference material describing how the API behaves
Agent Surfaces 2
MCP servers, agent skills, and machine-readable catalogs
Design & Contract 2
Pagination, idempotency, versioning, errors, and events
Build 1
SDKs, sample code, and the tooling you integrate with
Access & Security 3
Authentication, authorization, and security posture
Operate 2
Status, limits, changes, and where to get help
Commercial 3
Pricing, plans, and the legal terms of use
Company 3
The organization behind the API
Other 6
Properties that don't map to a standard resource type
← All providers · Data indexed from github.com/api-evangelist/amerihealth-caritas · machine-readable index on apis.io