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. 


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.


HL7 FHIR Da Vinci PDex Plan Net IG

CMS Payer to Payer API

Let’s Get Started

Don’t just check the CMS compliance box…set your organization up for the future.