CMS has finalized a few critical Interoperability rules that directly influence how Payers deliver services. They are as follows: 

Patient Access API

CMS-regulated payers are required to maintain a secure standards-based API that allows patients easy access to their data such as claims, encounters, and a set of clinical data. Patients should be able to access their data through any third-party application of their choice. 

Provider Directory API

CMS-regulated payers are required to make the provider directory APIs publicly available. Payers must make the list of providers under their plans publicly available so that their members can choose health plans according to their needs.

Payer to Payer Data Exchange

CMS-regulated payers are required to exchange clinical data at the patient’s request. They should allow patients to take their data with them when they move between payers. This enables them to have a cumulative record of their data.

For payers to comply with the mentioned rules, they need an all-in-one interoperability platform that fully understands their needs. The move to comply with the rules must be seamless and rapid to enable compliance within the deadlines. 

Aigilx health’s Interoperable solutions help payers transition into FHIR standard interoperability and comply with the CMS regulations. Implementation and migration are tool-driven, enabling a rapid and accurate go-live. With advanced features such as real-time metrics, payers can obtain data-driven insights to evaluate risks and engage in population health initiatives. 

Work with us to comply with the CMS regulations today and avoid penalties!

Aigilx health specializes in developing Interoperability solutions to create a healthcare ecosystem and aids in the delivery of efficient, patient-centric and population-focused healthcare.

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