CMS Rule Interoperability Mandate for Payers

CMS Interoperability Mandate

CMS recently introduced new interoperability mandates for health plans that must be implemented by July 1, 2021. These include:

  • Patient Access Rule - FHIR for members to share data with apps
  • Provider Directory API - FHIR API for a provider directory
  • Payer to Payer Data Exchange - Send and receive member data with other plans (Jan 2022)
  • Read more CMS patient access and interoperability requirements.

    1upHealth Solution

    1upHealth provides a fully managed solution to cover all new mandates. Our customers, including plans with millions of members, are already in production with 1up’s HHS award-winning API platform. Today, 100s of apps use 1up FHIR APIs to manage user directed connectivity across 1000s of health systems that we helped attest to similar patient access mandates. Plans can use the same infrastructure to meet all patient access and interop requirements.

    Integrated FHIR Platform as a Service

    All the features above are required to ensure success and security when meeting the new rules. Health plans must consider a broad list of interoperability, deployment, and support aspects to meet these mandates. 1up has everything health plans need to meet the regulations. You have flexibility and options with our platform and services and can utilize one module, a-la-carte, or the full solution for end-to-end use cases.
    1upHealth Architecture CMS patient access diagram for payer

    Why 1upHealth

    1upHealth is well positioned to support health plans in meeting the CMS requirements for the July 2021 deadline.

    Direct Payer Experience

    We have direct experience through our work with as one of the first approved Blue Button 2.0 apps, with health plans supporting millions of health plan members and the Da Vinci Project through workgroups and connectathons.

    Extensive Clinical Data Network

    We've worked with 100s of health systems across the US in meeting Meaningful Use 3 (MU3) requirements. We’ve now connected to 10,000+ hospital and health centers, allowing patients to authorize access to their EHR medical records with 3rd party applications.

    We are FHIR Experts

    Our team is comprised of leading FHIR experts who have presented alongside CMS and ONC leaders like Don Rucker, had led HL7 standard balloting, and participate in numerous FHIR connectathons

    Proven Platform for Regulation

    Because our award-winning FHIR solution is already in production, we can ensure timely deployment and meeting the requirements of the new rules.

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