NATE’s Trust Bundles

NATE currently operates the following trust bundles:


The flagship NATE Blue Button for Consumers (NBB4C) Trust Bundle contains trust anchors of consumer-facing applications (CFAs) that utilize Direct to securely move data from one application to another. The NBB4C Trust Bundle helps relying parties to identify CFAs that meet or exceed criteria considered to be the most important characteristics of a trustworthy steward of consumer health information, while still enabling patients to benefit from the value of having access to their health information.

Participation in the NBB4C Trust Bundle facilitates secure exchange of health information from provider-controlled applications to consumer-controlled applications such as personal health records (PHRs) using Direct secure messaging protocols. Provider organizations that wish to send messages to consumers using one of these recognized applications should load this bundle into their trust stores. In most cases, CFAs that are onboarded to the NBB4C have loaded publicly recognized trust bundles of provider facing applications and Direct Secure messaging should be enabled.

CFAs are welcome to submit an onboarding application and supplementary documentation online by using the NATE Bundles Administrator.  Go to to upload the completed form and supporting documentation.  New applicants will be required to create a profile to upload their documents and certificates, and must complete requisite testing by first adding their test trust anchor to the NBB4C staging bundle.  See How to Use the NBA for more instruction on how to apply and onboard.  Currently, NATE invoices qualified CFAs an administrative fee of $4,000 before being added to the production NBB4C trust bundle.

Go to NBA to Download NBB4C Trust Bundle
Download the NBB4C Onboarding Application
NBB4C Policies and Procedures
NBB4C Presentation
How to Use the NBA

NBB4C Staging

The NBB4C Staging Bundle is a non-production bundle that is used by candidate consumer-facing applications to conduct the testing required by the NBB4C onboarding process.

This bundle is also used by NATE and the consumer-facing applications in the NBB4C to give demonstrations, such as those offered as part of the HIMSS Interoperability Showcase.

Demonstration Trust Bundle

The Demonstration Trust Bundle is a non-production bundle used by provider-facing applications such as electronic medical records systems (e.g. Cerner, Epic, etc.) when participating with NATE in demonstrations such as the HIMSS Interoperability Showcase.

NATE Bundles Administrator (NBA)

To accommodate rapid growth in trust bundle participation, NATE designed and developed a new trust bundle administration tool known as the NATE Bundles Administrator (NBA).  The NBA facilitates the onboarding process and publishes bundles for download by relying parties that wish to adopt them as part of their patient engagement activities.

The NBA serves as a secure portal for downloading trust anchors for use in a relying party’s trust store as well as for uploading documentation related to onboarding to NATE trust bundles.  Interested CFAs should upload their onboarding applications and supplementary documentation using the NBA.  New applicants will be required to create a profile to upload information, documentation and trust anchors.

How to Use the NATE Bundles Administrator (NBA)

Understanding Trust Bundles

Check out this short primer on How NATE Trust Bundles Work.

Deprecated Trust Bundles

Blue Button Plus

NATE has deprecated the Blue Button Plus (BB+) Patient and Provider Trust Bundles.

NATE took over administration of the BB+ bundles in August 2014 on behalf of the pilot community.  Since taking over this task for the community, NATE followed a multi-month process to notify participants of NATE’s intention to migrate the legacy BB+ bundles to the new NATE Bundles Administrator.  During the migration process, very few of the legacy pilot participants elected to migrate to the new administration tool, citing their move to other bundles that had ascended since initiation of the BB+ pilot in 2013, including NATE’s Blue Button for Consumers (NBB4C) Trust Bundle.  Consequently, the NATE Board of Directors made the decision to close the BB+ bundles to new applicants.  As of November 2015, there were no trust anchors found in the BB+ Provider Bundle and only one trust anchor in the BB+ Patient Bundle, held by an organization in the process of onboarding to the NBB4C.  Given this lack of participation, NATE has ceased operation of both of the BB+ pilot bundles.

Any organizations subscribed to the BB+ Bundles should consider subscribing to the NBB4C bundle.


NATE and the California Association of Health Information Exchanges (CAHIE) recently announced that CAHIE has assumed administration of the NATE Provider-to-Provider Trust Bundle for Direct messaging among providers. CAHIE has kicked off a national forum to help establish a voluntary governance process to manage and govern the new trust community.

The new trust community and trust bundle will draw from existing CAHIE and NATE policies and procedures as a foundation, and include the latest thinking on how to best promote secure exchange among providers using Direct messaging. The forum is open to all interested stakeholders, with priority granted to current participants in NATE’s Provider-to-Provider Trust Bundle.