Cover the NHCX sandbox exit flows that a provider system must support.
A provider system must cover the flows in this page for NHCX sandbox exit.
Use the FHIR bundle rules in Requests and Responses.
Use Payload Code Snippets for JWE payload preparation.
A provider must implement each callback endpoint that receives a payer response.
Decrypt a JWE payload with the provider private key.
Accept a ProtocolResponse when the payer cannot process the request.
Common validation rules
Rule
Provider action
FHIR profile
Validate each payload against the NRCES profile.
Correlation ID
Use the request API call ID as the callback correlation ID.
Receiver code
Match the callback receiver code to the request sender code.
Error response
Accept ProtocolResponse for decryption, validation, and protocol failures.
Use cases
1. Get Participant List
Item
Requirement
API to call
POST /fetch/participants/list
API to implement
None
API owner
NHCX
Bundle
None
Status
None
Callback logic
None
2. Get Policy
Item
Requirement
API to call
POST /participant/get/policies
API to implement
None
API owner
NHCX
Bundle
None
Status
None
Callback logic
None
3. Get Public Key
Item
Requirement
API to call
POST /fetch/certs
API to implement
None
API owner
NHCX
Bundle
None
Status
None
Callback logic
None
4. Get Auth Token
Item
Requirement
API to call
POST /get/session
API to implement
None
API owner
NHCX
Bundle
None
Status
None
Callback logic
None
5. Check Coverage Eligibility
Item
Requirement
API to call
POST /v1/coverageeligibility/check
Callback API to implement
POST /v1/coverageeligibility/on_check
API owner
Payer
Request bundle
CoverageEligibilityRequestBundle
Success bundle
CoverageEligibilityResponseBundle
Request status
request.initiated
Success status
response.completed
Callback logic
Decrypt CoverageEligibilityResponseBundle or process ProtocolResponse.
6. Request Insurance Plan Details
Item
Requirement
API to call
POST /v1/insuranceplan/request
Callback API to implement
POST /v1/insuranceplan/on_request
API owner
Payer
Request bundle
TaskBundle
Success bundle
InsurancePlanBundle in TaskBundle output
Request status
request.initiated
Success status
response.complete
Callback logic
Decrypt the insurance plan response or process ProtocolResponse.
7. Submit Preauthorization
Item
Requirement
API to call
POST /v1/preauth/submit
Callback API to implement
POST /v1/preauth/on_submit
API owner
Payer
Request bundle
ClaimBundle
Success bundle
ClaimResponseBundle
Request status
request.initiated
Success status
response.complete
Callback logic
Decrypt the adjudicated preauthorization response or process ProtocolResponse.
8. Respond to a Communication Request
Item
Requirement
API to receive
POST /v1/communication/request
Callback API to call
POST /v1/communication/on_request
Callback API owner
Payer
Response bundle
TaskBundle with Communication
Success status
response.complete
Callback logic
Send the requested attachment or send a protocol error.
9. Submit a Claim
Item
Requirement
API to call
POST /v1/claim/submit
Callback API to implement
POST /v1/claim/on_submit
API owner
Payer
Request bundle
ClaimBundle
Success bundle
ClaimResponseBundle
Request status
request.initiated
Success status
response.partial or response.complete
Callback logic
Decrypt the adjudicated claim response or process ProtocolResponse.
10. Search Claim Data
Item
Requirement
API to call
POST /v1/search/submit
Callback API to implement
POST /v1/search/on_submit
API owner
Payer
Request bundle
TaskBundle with task code search
Success bundle
TaskBundle with ClaimResponse output
Request status
request.initiated
Success status
response.partial or response.complete
Callback logic
Decrypt the search result bundle or process ProtocolResponse.
11. Acknowledge a Payment Notice
Item
Requirement
API to receive
POST /v1/paymentnotice/request
Callback API to call
POST /v1/paymentnotice/on_request
Callback API owner
Payer
Response bundle
TaskBundle with Task output
Success status
response.complete
Callback logic
Send ACKNOWLEDGED or RECEIVED in the task output.
12. Request Reprocess or Cancel
Item
Requirement
API to call
POST /v1/task/submit
Callback API to implement
POST /v1/task/on_submit
API owner
Payer
Request bundle
TaskBundle
Success bundle
TaskBundle with ClaimResponse output
Request status
request.initiated
Task code
reprocess, cancel, release, or nullify
Callback logic
Decrypt the task response or process ProtocolResponse.
13. Get Status
Item
Requirement
API to call
POST /v1/status
Callback API to implement
POST /v1/on_status
API owner
NHCX
Request bundle
Empty payload
Success bundle
Protocol header only
Request status
request.initiated
Callback status
request.dispatched
Callback logic
Accept the status callback with all protocol header attributes.
