Interoperability Solution for Health Plans

Enable digital connectivity to deploy consumer-directed health data sharing

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:

  • Medical and drug claims data
  • Provider and Pharmacy directory data
  • Formulary or preferred drug list data
  • Clinical data, if maintained by the plan

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, member authentication, 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.