CMS Interoperability - Healthchain

Stay Ahead of Regulations. Empower Data-Driven Care.

Simplifying Interoperability and Mandate Adherence

The healthcare landscape is evolving, with the CMS interoperability mandates reshaping how information is exchanged across the industry. For health plans, meeting these regulations isn’t just a compliance exercise—it’s an opportunity to enhance access to data, streamline collaboration with providers and take a more proactive role in their members’ care journeys.

The Challenges in CMS Compliance

Navigating Interoperability Mandates

Complex requirements such as the Prior Authorization API, Provider Access API, Patient Access API, Provider Directory API & Payer-to-Payer API, demand comprehensive knowledge of HL7^® FHIR^® standards.

Fragmented Data Across Systems

Health plans often operate with legacy systems and data formats, making it challenging to achieve a unified view of the member data they maintain in their environment to be made available via FHIR APIs.

Compliance is Viewed as a Cost Center

The perception among stakeholders is often that the CMS interoperability mandates are just another compliance requirement impacting the health plan’s bottom line.

Educating Providers through Collaboration

The interoperability mandates have resulted in Providers being required to be more collaborative with Payers, but health plans have not been able to show impactful value to their provider partners in return.

How We Solve It

Seamless Compliance with Interoperability Standards

FHIR-Ready Infrastructure :
Our FHIR-native Health Data Management Platform enables full compliance with APIs required by the CMS, including the Patient Access API, Payer-to-Payer API, Prior Authorization API, Provider Directory API and Provider Access API. By leveraging a FHIR-native data fabric, health plans can activate FHIR APIs, while enabling reliable analytics on top of a Common Data Model.

Automated Updates for Regulatory Compliance:
With built-in adaptability, we ensure Payers systems stay aligned with evolving CMS mandates, reducing the burden of manual reconfigurations.

Data Ingestion & Standardization

Source Data Connectors and FHIR Conversion:
We bring disparate data sources & formats together, creating a comprehensive, normalized view that supports FHIR-based, standardized, and reliable data exchange across organizations.

Enterprise Master Patient Index (EMPI) & Curation:
Accurately match both patient and provider records across systems, merge and eliminate duplicate records and ensure the data being exchanged meets regulatory standards.

Bi-Directional Collaboration

Developer Portal for secure API Exposure:
Enable seamless & secure third-party integrations with and management of FHIR APIs in order to share the value being created from the mandates with Providers and Members.

Proactive Care Coordination & Collaboration:
Leverage the data being shared by Providers to proactively reduce the burden they face in managing the care members receive.

Learn more about achieving CMS compliance

EmpoweringBusinessUserswithRealTimeDataAccess

Why It Matters

By solving these challenges, health plans can

Achieve Full Compliance

Avoid penalties while gaining competitive advantage.

Streamline Collaboration

Enable seamless data sharing across payers, providers, and third parties.

Improve Member Trust

Deliver transparency and security in handling sensitive information.

Accelerate Transformation

Leverage the CMS interoperability mandates to accelerate digital transformation across the health plan.

Discover how we address other key challenges for Health Plans

Explore More Problems We Solve

Utilization Management

Optimize medical cost containment and MLR compliance.

Quality Improvement

Drive better Star Ratings and meet HEDIS benchmarks.

Risk Adjustment

Optimize reimbursements through data-driven insights.

Turn Mandates into Momentum

Leverage compliance as a catalyst for innovation, member satisfaction, and operational excellence.

Contact Us Today

Perspectives by Health Chain

Leveraging Technology Partners to Accelerate Different Stages of the CDI Value Chain
Gallery
Leveraging Technology Partners to Accelerate Different Stages of the CDI Value Chain

Health Information and Interoperability, Health IT Digital Transformation, Healthcare Analytics, Healthcare IT Digital Evolution

Leveraging Technology Partners to Accelerate Different Stages of the CDI Value Chain

Clinical Data Integration (CDI) offers tremendous value for health plans, but it's a complex process with diverse needs at each stage.

Data Variability and Standardization: Key Hurdles in Effective CDI
Gallery
Data Variability and Standardization: Key Hurdles in Effective CDI

Health Information and Interoperability, Health IT Digital Transformation, Healthcare Data Aggregation & Curation, Healthcare IT Digital Evolution

Data Variability and Standardization: Key Hurdles in Effective CDI

Conquer data variability, the biggest hurdle in CDI! Discover how Health Chain's Centaur™ platform tackles data inconsistencies & unlocks actionable insights for better member care & financial performance.

Demystifying the Maze: A Deep Dive into the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) for Health Plans
Gallery
Demystifying the Maze: A Deep Dive into the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) for Health Plans

CMS Mandates, Compliance, Health Information and Interoperability, Health Plan Operations

Demystifying the Maze: A Deep Dive into the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) for Health Plans

The Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) in January 2024.

Explore More Blogs