A Unified Platform for FHIR APIs
In an increasingly interconnected healthcare ecosystem, FHIR APIs are the backbone of interoperability. HDIG’s Interoperability Platform and Developer Portal provide the foundation to deploy, test, and activate any FHIR API with ease. From secure authentication and consent management to sandbox environments for development, HDIG equips organizations with the tools needed to unlock the full potential of FHIR-based data exchange.
The Launchpad for FHIR APIs
HDIG makes deploying FHIR APIs seamless and secure. Test in sandbox environments, leverage advanced authentication and consent management tools, and activate specific FHIR-based resources effortlessly across APIs—all from one central platform.
Activating FHIR APIs
Streamlining Prior Authorization Submission and Review
The Prior Authorization API digitizes what is a very manual, time consuming and flawed prior auth process today. The Prior Auth API addresses key bottlenecks in the current prior authorization process to optimize utilization management and care delivery.
Key Features:
- Coverage Requirements Discovery (CRD): Enables providers to check coverage requirements, with guidance returned from the Payer’s environment via our Rules & CQL Engine based on the specific order and the Payer’s coverage requirements
- Documentation Templates Rules (DTR): If a Prior Authorization is determined to be required, our DTR SMART on FHIR app launches to determine documentation needs, providing specific templates and rules required for documentation, which can be prepopulated based on the data available in Payer & Provider environment
- Prior Authorization Support (PAS): The PAS API sends the completed PA request to the Payer in the FHIR format for processing and an approval, status or decision is communicated back to the provider with a denial reason in the case of a denial
Usage Metrics:
- Metrics for Standard & Expedited PA requests
- Aggregated PA decisions
- % of PA approved
- % PA denied
- % PA approved post appeal
- Average time between submission & decision
Empowering Patients Through Data Transparency
The Patient Access API allows third-party applications to access essential member data based on patient consent. This includes benefits information, clinical data, formulary, and provider directory information.
Key Data Resources:
- Explanation of Benefits (Carin BB)
- US Core – Clinical (upgraded to 6.1.0)
- Formulary and Provider Directory (STU 1.0/1.1)
- Prior Authorization Information
Usage Metrics:
- Aggregated reports of data shared via API to CMS
- Unique and recurring data transfers
Enhancing Collaboration with Providers
This API enables specific providers to access clinical and administrative data for members based on member match & consent, streamlining care coordination and administrative workflows.
Key Data Resources:
- New FHIR Bulk API for Providers
- Explanation of Benefits (Carin BB) – Excludes cost data
- Active and past Prior Authorizations
- Encounter and clinical data
Additional Capabilities:
- Manage Provider API access
- Attribution processes to map members to providers
Secure and Reliable Payer-to-Payer Data Exchange
Facilitates seamless sharing of member data between payers, ensuring continuity of care and accurate records during member transitions between health plans.
Key Data Resources:
- Claims & Encounter data (excluding costs)
- All supporting clinical data
- Active Prior Authorizations
- Prior Authorizations with status change in the last year
- Data within service date of 5 years
Advanced Features:
- Automated member match operations
- Multiple member match
- Opt-in preferences for data sharing
- Manage concurrent coverage
- Bulk FHIR
- Meet accelerated data exchange timelines
Enables members, providers, and third-party applications to publicly access up-to-date data on a payer’s network of contracted providers.
Key Data Resources
- Provider Names
- Addresses
- Phone Numbers
- Provider Specialties
Additional Capabilities
Directory information must be available to current and prospective enrollees and the public within 30 calendar days of a payer receiving provider directory information or an update to the provider directory information.
