Overview for Developers

Overall background on the CMS Interoperability and Patient Access Rule for your apps to access FHIR R4 Payer data

This July 2021 (and the months leading) 1upHealth will be supporting FHIR R4 data from 100s of Health Plans (Health Insurance Companies) like Aetna, Cigna, etc. This is a massive opportunity to build applications on Claims, Financial, and Clinical data that will become available for millions of new patient / member connections.

This is the result of the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access mandate.โ€‹

What you need to know.

  • Your apps will not work automatically with these health plans and FHIR R4 Data. You need to modify your apps to support FHIR R4 (revision 4) and new data types. Please scope out some time (budget 2 weeks - 1 month) to get your apps ready before July.

  • 1upHealth will support 2 methods of connectivity:

    1. Via your existing interfaces with our Connect API (paid), and

    2. Via direct connections to some of these health plans (free)

  • In order for your application to be visible to members at these health plans you will need to update your apps and demonstrate support for R4 as well as provide some additional application details (logo, description, etc.) if you have not already done so. See more information in Getting Started with CMS R4 APIs.

This is massive news because adoption of R4 will create a true standard and another important step towards true FHIR interoperability. FHIR R4 builds on the already existing legacy of DSTU2 and STU3 which enables access to patientโ€™s clinical data, all of which you can access via the 1upHealth FHIR API platform. Some of the CMS most common R4 resources that will further expand the amount of data youโ€™re able to query include:

  • Claims

  • ExplanationOfBenefit

  • Coverage

  • Organization

  • Patient

  • Practitioner

  • OrganizationAffiliation

What does all of this mean?

FHIR R4 is considered to be even more stable where all of the future FHIR versions will begin to be backward compatible with the R4 components outlined above. This means you will now have more access to data, and dedicate more time to where it really matters; the patient.