---
Title: Rapid Member Pass Proposal
---
:::info
Note: this is a ***draft**-paper* for discussion purposes.
:::
Proposal:
<font size="8">
<p style="text-align: left" class="docTitle"><b>Rapid Member Pass</b></p>
</font>
> [time=August 1, 2024] [name=Stephan Baur] [name=many coauthors]
# Rapid Member Pass
Today's image-based digital forms of health insurance cards lack a standard way to digitally transfer the card data when registering online or in-person at a care provider. Images by themselves are neither tamper-evident nor can the authenticity of issuer and holder be digitally verified.
**`Rapid Member Pass`** is a new digital health insurance card that can be stored by members or caregivers in their **`identity wallet app`**. Based on emerging open Internet, ISO/IEC, and HL7 standards (W3C, Open Identity Foundation, SMART Health Digital Insurance Card) its data format and transfer protocols are interoperable. This means high reusability of digital solutions across other use cases and industries. For example, mobile Driver License Apps could be used as the **`identity wallet app`** so that a patient's identity can be verified and authenticated along with tamper-evident proof of coverage (or entitlement). Furthermore, a provider can be confident that links to APIs in the card data are also authentic.
**`Rapid Member Pass`** creates *r*e-usable, *a*uthentic, and *p*ersonal *i*dentity *d*ata! It uses the HL7 standard for SMART Health Digital Insurance Card to get interoperable, tamper-evident card data formats. It proposes a small extension to add **verifiable identity** and **authentication** of the holder (member) through **cryptographic authenticator binding** conforming to standards by aforementioned bodies.
**`Rapid Member Pass`** is the foundation to design and implement **cross-boundary user journeys** in healthcare: Once it is in their **`identity wallet app`**, members can digitally interact and transact with participating provider portals (or any website that needs to authenticate users and validate their insurance data) **without needing to setup an account manually**.
:::info
Note: It is possible to do some of this with current practices of Single Sign-On (SSO) with Federated Identity. However, when the privacy concern associated with metadata about interactions (that an Identity Provider (IDP) will be able to aggregate and use) must be addressed, or the scalability limitations of SSO, the **decentralized** approaches enabled by **`Rapid Member Pass`** become paramount.
:::
**Value Outcomes**:
* For the user, **`Rapid Member Pass`** creates more integrated digital experiences across a network of participating websites where they can re-use their identity and prove enrollment entitlement or coverage. Consumers start to experience being a customer of an ecosystem rather than of individual companies.
* For both participating payers and providers, it creates cost savings and efficiencies in onboarding to digital services as identity and authenticity (Login with wallet) can be verified
* For care providers it also helps avoiding the costly typos in manually transferring member card content -they can also store the transferred data for later reference and avoid the need to photocopy plastic cards.
::: spoiler References
> **HL7:** https://hl7.org/fhir/us/insurance-card/STU1.1/index.html
> **W3C:** Verifiable Credential Data Model and Decentralized Identifiers
> **Open Identity Foundation:** OID4VCI/VP
> **ISO**: mDL and mDoc
> [color=#f455e2]
:::
# Cross-boundary User Journeys
The **`Rapid Member Pass`** proposal aims to address the end-to-end flows across the two segments (1) employer (or government) to payer and (2) payer to provider (or pharmacy).
To address (1), it defines a second kind of 'card' that goes into the user's identity wallet app: The employee's digital **`Employee-id`**.
These 'cards'
:::success
It is also likely that additional paths become available, e.g., a patient's use of Digital Therapeutics, subsidized consumeer health products, etc.
:::
## Onramp to the Rapid Member Pass Loop
## Expanding to Ecosystem Network
Specified as an Open Standard to warrant interoperability: Participating websites offer simple, seamless, and coherent user journeys across the entire Health Care sector, including employers and government agencies.
# Use Cases for POC
## At Employer
| # | Use Case | Description | Value Capture |
|:---:|:------------------- |:--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |:------------------------------------ |
| | | | |
| 1 | I-9 ID Proofing | Use of mDLs creates efficiencies for ID proofing. While that often is not direclty done by the employer's HR office it allows to securly recongize new hires when transitioning into internal IT systems. As Verifiable Credentials become more adopted in professional credentialling, e.g., physcians and nurses, significant simplification in employee onboarding is created. Additionally, the contractor onboarding benefits from this.| Time and cost in employee onboarding |
| 2 | Proof of employment | | Value 2 |
| 3 | Case3 | Description 3. |
## At Payer
| # | Use Case | Description | Value Capture |
|:---:|:---------------------------------- |:-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |:-------------------------------------------------------------------------------------------------------------------------------------------------- |
| 1 | Case1 | Description 1. | Value 1|
| 2 | Case2 | Description 2. | Value 2|
| 3 | Case3 | Description 3. | Value 2|
## At Care Provider
### Prerequisites
- [x] Rapid Member Pass in identity wallet app
- [x] Patient navigated to provider portal's appointment scheduling page
- [x] Option: Referal by PCP
| # | Use Case | Description | Value Capture |
|:---:|:---------------------------------- |:-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |:-------------------------------------------------------------------------------------------------------------------------------------------------- |
| 1 | First-time appointment made online | Via a QR scan (cross device) or clicking on link, the wallet exchanges the `Rapid Member Pass` with the website with an inherent instant holder-authentication. This is all that's needed for the provider portal to create a new patient account and generate an MRN. Patient defines username/password or passkey authenticator or defers this to later and keeps using "login with Rapid Member Pass" when returning back to the portal. Optionally, the CA mDL is also exchanged to gain an extra ID verification. Then, patient is redirected to the appointment creation page. | **Lower cost**: no extra IDV, no manual insurance card intake; **Better UX/patient engagement**: automatic account creation at initial interaction |
| 2 | Register at medical office | When showing up to the appointment patient simply needs to prove identity and MRN (presumable identity alone suffices for check in to an existing appointment). Options: (1) current procedure with physical Driver Licenses verification; (2) CA DMV app's mDL/ID is verified with QR or BLE/NFC scan from a standalone scanner or the check-in clerk's mobile app; (3) repeat use case #1 `Rapid Member Pass` exchange with instant holder-authentication. | Maintained **optionality**; **higher fraud resilience** and/or **more convenience**; |
| 3 | Walk-in at medical office | Patient has never been at provider and the check-in clerk provides a QRC to initiate account creation: Use case #1 is followed exchanging the `Rapid Member Pass` with instant holder-authentication. This creates the new patient's portal account with all insurance card data recorded and the walk-in visit can be proceeded like with an existing patient.| Same as in use case #1 plus: Because of automatic portal account creation the walk-in patient can **immediately access own clinical data and digitally engage with care team** even when later returning to the portal (by using `Rapid Member Pass` to log in) |
# Proposal
## Rapid Member Pass as VC
In essence, the [HL7 SMART Health Digital Insurance Card](https://build.fhir.org/ig/HL7/carin-digital-insurance-card/General_Guidance.html#a-payer-to-provide-members-with-smart-health-digital-insurance-cards) will be wrapped by a slightly modified SMART Health Card JWS so that it becomes conformant with the W3C Verifiable Credential [security wrapper](https://www.w3.org/TR/vc-data-model/#jwt-encoding) and uses a Decentralized Identifier for the issuer and subject.
See separate [post](https://hackmd.io/@steba/HJxeTBYtR).
<!--- hide this
:::spoiler SMART Health Digital Insurance Card as W3C Verifiable Credential
```javascript=
{ /* JWS header: */
"alg": "ES256",
"typ": "JWT",
"kid": "did:<method-for-issuers>:<d-identifier>#<key-identifier>" // add
},
{ /* JWS payload: */
"vc": {
"@context": "[https://www.w3.org/ns/credentials/v2]",
"type": [
"https://smarthealth.cards#health-card",
"VerifiableCredential", // add
"HealthPlanCoverageProof", // add -may require more conext
"HealthPlanEnrollmentRequest" // add -may require more context
],
/* SMART Health Digital Insurance Card data model (HL7) */
"credentialSubject": {...}
},
"iss": "did:<method-for-issuers>:<d-identifier>", // change
"jti": "http://<issuer's-domain>/credentials/<cred-id>", // add
"sub": "did:<method-for-users>:<d-identifier>", // add
"nbf": "1722363939",
"exp": "1816974451" // add
// aud MUST be present when presented (in Verifiable Presentations)
},
{ /* JWS signature: */
"yB0o52V6QpmgMhU_m1IYa7aaxTPZbATkrXj9LxTCDzx2RM49Msbv458ZUpc TI_JjQwinxf8-MS_IX2urG1SMgA"
}
```
:::
:::spoiler SMART Health Card payload {...}:
```javascript=
"credentialSubject": {
"fhirVersion": "4.0.1",
"fhirBundle": {
"resourceType": "Bundle",
"type": "collection",
"entry": [
{
"fullUrl": "resource:0",
"resource": {
"resourceType": "Coverage",
"id": "Example-Coverage1",
"meta": {
"versionId": "1",
"lastUpdated": "2021-04-06T10:49:02.473+00:00",
"profile": [
"http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Coverage"
]
},
"text": {
"status": "generated",
"div": "<div xmlns='http://www.w3.org/1999/xhtml'>Acme Gold Plus</div>'"
},
"extension": [
{
"extension": [
{
"url": "memberId",
"valueId": "102345672-01"
},
{
"url": "name",
"valueHumanName": {
"family": "Doe",
"given": [
"John"
]
}
}
],
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"
},
{
"extension": [
{
"url": "memberId",
"valueId": "102345672-02"
},
{
"url": "name",
"valueHumanName": {
"family": "Doe",
"given": [
"Jane"
]
}
}
],
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"
},
{
"extension": [
{
"url": "memberId",
"valueId": "102345672-03"
},
{
"url": "name",
"valueHumanName": {
"family": "Doe",
"given": [
"Jimmy"
]
}
}
],
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"
},
{
"extension": [
{
"url": "memberId",
"valueId": "102345672-04"
},
{
"url": "name",
"valueHumanName": {
"family": "Doe",
"given": [
"Ginny"
]
}
}
],
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-PlanBeneficiaries-extension"
},
{
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-AdditionalCardInformation-extension",
"valueAnnotation": {
"text": "If you use a TTY, call 711.\nYou may be asked to present this card when you receive care or fill a perscription. This card does not gaurentee coverage. Intentionally misusing this card may be considered fraud or a violation of the law.\nWe encourage you to use a primary care physician as a valuable resource and personal health advocate."
}
},
{
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-CardIssueDate-extension",
"valueDate": "2020-12-15"
},
{
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BackgroundColor-extension",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/IECColourManagement",
"code": "#00bfff"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-HighlightColor-extension",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/IECColourManagement",
"code": "#ceebf5"
}
]
}
},
{
"extension": [
{
"url": "label",
"valueString": "ACME Inc."
},
{
"url": "description",
"valueString": "Company logo"
},
{
"url": "image",
"valueAttachment": {
"contentType": "image/png",
"data": "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"
}
}
],
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Logo-extension"
},
{
"extension": [
{
"url": "label",
"valueString": "Some lable for this QR code"
},
{
"url": "description",
"valueString": "Usage text for this QR code for the end user"
},
{
"url": "image",
"valueAttachment": {
"contentType": "image/png",
"data": "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"
}
}
],
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-QRCode-extension"
},
{
"extension": [
{
"url": "label",
"valueString": "Some label for this Barcode"
},
{
"url": "description",
"valueString": "Usage text for this Barcode for the end user"
},
{
"url": "image",
"valueAttachment": {
"contentType": "image/png",
"data": "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"
}
}
],
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-Barcode-extension"
},
{
"extension": [
{
"url": "label",
"valueString": "Some label text"
},
{
"url": "description",
"valueString": "Some text for the end user about the usage/meaning of this image"
},
{
"url": "image",
"valueAttachment": {
"contentType": "image/png",
"data": "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"
}
}
],
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-SupportingImage-extension"
}
],
"identifier": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MB",
"display": "Member Number"
}
]
},
"system": "https://www.acmeinsurance.com/glossary/memberid",
"value": "102345672-02",
"assigner": {
"display": "Acme Insurance Co"
}
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "HIP",
"display": "health insurance plan policy"
}
],
"text": "health insurance plan policy"
},
"subscriber": {
"reference": "Patient/Example-Patient1",
"display": "John Doe"
},
"subscriberId": "102345672-01", // this is the member identifier associated with the VC holder (whose DID is referenced in the "sub" key of the JWT)
"beneficiary": {
"reference": "Patient/Example-Patient2",
"display": "Jane Doe"
},
"dependent": "02",
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "spouse",
"display": "Spouse"
}
],
"text": "Spouse"
},
"period": {
"start": "2021-01-01"
},
"payor": [
{
"reference": "Organization/Example-PayerOrganization1",
"display": "Acme Insurance Co"
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "group"
}
]
},
"value": "993355",
"name": "Stars Inc"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "plan"
}
]
},
"value": "11461128",
"name": "Acme Gold Plus"
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS",
"code": "division"
}
]
},
"value": "11"
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCoverageClassCS",
"code": "network"
}
]
},
"value": "561490",
"name": "Acme Gold Plus South"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "rxbin"
}
]
},
"value": "100045"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "rxpcn"
}
]
},
"value": "1234000"
}
],
"costToBeneficiary": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
"code": "FamOutDed",
"display": "Family Out of Network Deductible"
}
]
},
"valueMoney": {
"value": 10000,
"currency": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
"code": "FamInDed",
"display": "Family In Network Deductible"
}
]
},
"valueMoney": {
"value": 8000,
"currency": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
"code": "FamRxOutDed",
"display": "Family Pharmacy Out of Network Deductible"
}
]
},
"valueMoney": {
"value": 2000,
"currency": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
"code": "FamRxInDed",
"display": "Family Pharmacy In Network Deductible"
}
]
},
"valueMoney": {
"value": 1500,
"currency": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
"code": "FamOutMax",
"display": "Family Out of Network Out of Pocket Maximum"
}
]
},
"valueMoney": {
"value": 12000,
"currency": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
"code": "FamInMax",
"display": "Family In Network Out of Pocket Maximum"
}
]
},
"valueMoney": {
"value": 10000,
"currency": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
"code": "FamRxOutMax",
"display": "Family Pharmacy Out of Network Out of Pocket Maximum"
}
]
},
"valueMoney": {
"value": 3000,
"currency": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
"code": "FamRxInMax",
"display": "Family Pharmacy In Network Out of Pocket Maximum"
}
]
},
"valueMoney": {
"value": 2000,
"currency": "USD"
}
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
"code": "gpvisit"
}
]
},
"valueMoney": {
"extension": [
{
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension",
"valueString": "N/A"
}
]
}
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
"code": "spvisit"
}
]
},
"valueMoney": {
"extension": [
{
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension",
"valueString": "N/A"
}
]
}
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-copay-type",
"code": "emergency"
}
]
},
"valueMoney": {
"extension": [
{
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension",
"valueString": "N/A"
}
]
}
},
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/insurance-card/CodeSystem/C4DICExtendedCopayTypeCS",
"code": "rx"
}
]
},
"valueMoney": {
"extension": [
{
"url": "http://hl7.org/fhir/us/insurance-card/StructureDefinition/C4DIC-BeneficiaryCostString-extension",
"valueString": "DED THEN $10/$40/$70/25%"
}
]
}
}
]
}
}
]
}
}
```
:::
--->
# Go deeper
## Where Value Is
### Employer to Payer:
* *Experience*: Seamless transition from benefit selection to enrollment, account creation, and issuance of digital member card (Rapid Member Pass).
* Allows to start pre-effective-date activities like setting up dependents’ accounts, schedule appointments, starting prevention programs.
* Creates opportunity to guide user to select more secure authentication (MFA, passkeys).
* **Cost savings**: if identify verification remains needed, can be done via mobile Driver License instead of thrid party.
* VC-based enrollment requests could simplify B2B communications
:::info
Note: a lighter form is possible as a trade-off to not depend on benefit managers –issue a “Verified Employee” credential using Microsoft 365 (Entra Verified ID).
:::
### Medicaid, Exchanges to Payer:
* Acts as a self-insured ’employer’ to issue the Beneficiary ID card in from of an Enrollment Request.
* End-to-end digital verification flows simplify processing of this frequently changing entitlement, thus amplifies saving potential.
### Payer to Provider:
* Future protocol extensions provide an SMS alternative for notifications to the wallet. This can simplify authentication across digital channels, e.g. Advise Nurse calls.
* Digital interactions with provider can be authenticated with Rapid Member Pass. This unifies the member experience when connecting to provider to schedule appointments and become reachable for notifications.
* Furthermore, it makes patient matching deterministic and allows to automate clinical data flows for care coordination.
* Remove clerical typos when manually capture payer and coverage information from physical cards or presented card images on smartphones.
### Other Uses:
* Patient identity and authentication in clinical trials, clinical research as care option, and simplified, delegable (anonymized) data sharing consent.
---
## Summary Description:
* Across healthcare, digital insurance cards are generally graphically rendered images via web or mobile apps. Their primary use is to convey coverage and contact information at check-ins to office visits –a manual “show and intake” process.
* Rapid Member Passes are standardized (HL7) data sets, cryptographically signed by the health insurer (issuer) thus tamper-proof and digitally verifiable without checking with the issuer.
* At in-person check-in, using an interoperable digital identity wallet the coverage data is transmitted like in point-of-sales experiences where it includes a biometric identity authentication step (digital or manual).
* At online check-in, when no portal account exists yet, the transfer from the wallet includes an authentication step with the pass. This suffices to create the account for the patient without further interaction.
* In both cases, in-person or online, the patient will automatically receive portal access (login to account) and experience a seamless transition between in-person and online interactions.
* With supporting HR systems, Rapid Member Passes can be issued quickly during enrollment: once the new employee selected a health plan the HR system (or proxy service) sends a digital “Benefits Enrollment Request” to the person’s id wallet app and redirects to the health plan’s member onboarding web page. There, in exchange to the voucher, the Rapid Member Pass is issued.
* With participating care providers and pharmacies, Rapid Member Passes give KP members fast and easy digital access –as if it was within the KP network.
* With participating Medicaid agencies, a beneficiary can easily prove eligibility which can be verified at less cost and very rapidly.
# Technology Shifts
1. W3C Verifiable Credential Data Model (VCDM)
1. W3C Decentralized Identifiers (DID)
1. Open Identity Foundation: OID4VCI
1. Mobile Driver License
# Diagrams
## Flows
## UX
New ways for group customers to provide digital confirmation to enroll employee in a benefit plan (this could also be the model for Medicaid and Medicare):
New form of digital member card is machine-readable and issued directly to a member’s digital identity wallet app:
New ways for members to provide proof of coverage and authentication in-person or online in onboarding to new portal accounts and login with Rapid Member Pass:
## Architecture:
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</style>
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