Compliance
CMS Interoperability Rules
We deliver a solution that meets each requirement of the CMS Interoperability & Patient Access final rule and sets your organization up with the foundation to accommodate future (inevitable) rule changes.
The fastest way to comply with CMS Interoperability & Patient Access Rules
HealthLX provides a fully managed solution to satisfy all new mandates for the CMS Patient Access final rule (CMS-911-F). We’re ready to help organizations satisfy the newly proposed rule CMS-0057-P, for interoperability and prior authorization. Read the comments we submitted during the open comment period.
Core Data Sharing Requirements
1 Claims & Encounters – Including encounters with capitated or delegated providers.
2 Clinical/USCDI – US Core Data Interoperability.
3 Cost Data – Provider payment amounts and enrollee cost-sharing amounts.
4 Formulary/Preferred Drug List – Implementation Guide to help members select a coverage type during enrollment for the medications they are currently on is HL7 FHIR Da Vinci – PDex US Drug Formulary IG: Version STU 1.0.1.
5 Provider Directory -The Implementation Guide is HL7 FHIR Da Vinci PDex Plan Net IG: Version STU 1.0.0.
CMS Patient Access Rule
Payers must make patient health care claims and clinical information available to members through a standards-based API for Medicare Advantage, Medicaid and CHIP FFS, Medicaid and CHIP managed care, and QHPs on the FFES.
SUPPORTING IMPLEMENTATION GUIDES:
CMS Provider Directory API
Payers must make provider directories available through a standards-based API that is accessible on a public-facing digital endpoint on the payer’s website.
SUPPORTING IMPLEMENTATION GUIDE:
CMS Payer to Payer API
Payers will be required to exchange patient USCDI data upon request.
SUPPORTING IMPLEMENTATION GUIDES: