The health insurance industry is facing a major change with new legislation with the CMS Interoperability & Patient Access Final Rule and the 21st Century Cures Act.
Payers have increased responsibility in patient data access and their ability to operate with 3rd party healthcare applications. Payers are now required to offer a FHIR-based Provider Directory by July 1st, 2021.
There are several ways payers can meet this important deadline:
The Helios FHIR Server – Provider Directory is a commercial-grade, clinical data solution based on the HL7® FHIR® standard that provides out-of-the-box support for the Provider Directory requirements of the CMS Interoperability and Patient Access Final Rule. It implements and has been tested for compliance with the HL7® FHIR® DaVinci PDEX Plan Net Implementation Guide.
A provider directory enables 3rd parties to develop applications that consumers and providers can query the participants in a payer’s network. This fulfills one of the core requirements of the CMS Final Rule and the 21st Century Cures Act. The CMS Final Rule focuses heavily on interoperability. It aims to start the process of liberating data and ensuring patients are the primary beneficiary of this process, and a provider directory is exactly what you need to accomplish this interoperability.
On January 2021, the CMS Interoperability and Patient Access Final Rule will begin to take effect (with a 6-month discretionary period due to the pandemic). By July 2021, CMS requires a new standard for both a patient access API and provider access API.
The patient access API impacts payer organizations in a significant way. It requires them to implement, test, and monitor a secure standard-based API that is accessible to third-party apps and developers. Importantly, these must be FHIR based APIs.