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
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: