The new CMS interoperability mandate on Medicare, Medicaid, CHIP, and ACA-Exchange plans requires specific data be released to members at their direction on smart phones, tablets, or web applications via open application programming interfaces (APIs) through the HL7 Fast Healthcare Interoperability Resources (FHIR) standards. FHIR enables users to access electronic health data (EHI) resources over the Internet via a standardized RESTful API, permitting third party applications to retrieve data with approval and direction of the plan enrollee.
Digital information plans must make available to members, their providers and other plans via APIs includes:
Through our partnership with Edifecs, a global health information technology solutions company, we deliver an end-to-end interoperability solution specifically designed and priced for small- midsized health plans.
We will provide data aggregation on a FHIR server, as well as trading partner management, consent validation and API management solutions, enabling the trusted exchange of secure data. Our solution allows both the release of required provider network, clinical, medical and pharmacy claims data available, and receipt of any data from members’ providers and prior plans so that you can meet the CMS Interoperability regulation and move forward strategically with interoperability..
SS&C Health is a trusted provider of healthcare solutions for over 35 years. We can help you discover opportunities for improved processes and more engaging consumer experiences, as you digitally transform your organization.