Payer

Innovaccer's CMS Compliance solution for greater healthcare payer interoperability

Team Innovaccer
Wed 28 July 2021
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The dynamic world of regulatory changes is ever-evolving. Most recently, the Centers for Medicare & Medicaid Services (CMS) issued the Interoperability and Patient Access final rule (CMS 9115-F) in March 2020, with enforcement of the Patient Access and Provider Directory API requirements beginning July 1, 2021. The Interoperability and Patient Access final rule, when implemented effectively, has the potential to change the way healthcare organizations operate. With increased access to information on their health status and healthcare opportunities, members will be empowered to manage their healthcare journeys.

Innovaccer's CMS Compliance solution is designed to go beyond CMS 9115-F compliance to solve critical security, privacy, and end-user challenges. Powered by the Innovaccer Health Cloud, key features of the solution include:

  • Data connectivity paired with data cleansing, standardization, and member-level aggregation capabilities
  • An FHIR server and API gateway with support for implementation guide-specified Health Level Seven® (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) operations
  • Payer admin workflows for day-to-day solution management
  • Member experience workflows covering authentication, consent management, and data access
  • Workflows for third-party app registration and certification

While the first milestone has passed, payers are evaluating whether their data systems are fit to comply with current and future requirements, including:

  • CMS 9115-F requirements for payer-to-payer data exchange (January 1, 2022, deadline)
  • CMS 9115-F requirements for federal-state data exchange (April 1, 2022, deadline)
  • CMS 9915-F requirements for transparency in coverage (January 1, 2022, initial phase deadline)
  • CMS 9123-P requirements for prior authorization burden and promoting patient electronic health information access (January 1, 2023, tentative initial phase deadline)

As the importance of interoperability and health information access grows, Innovaccer will help its partners meet regulations while staying ahead of the technology curve. CMS compliance and interoperability is not a "one-and-done" task; payers need to have a long-term compliance plan to unlock the full potential of increased information access and streamlined workflows.

What should payers do in the future?

Continue To Break Down Data Silos: While CMS regulations aim to improve API and electronic data exchange-driven interoperability, the underlying need for more efficient and effective member data management is also driving modernization. Improvements in how data is cleaned, standardized, normalized, aggregated, and stored will unlock downstream benefits when it comes to complying with upcoming regulations.

Solve For Rigorous Data Access And Consent Management: Improved availability of data increases the need to manage how data is used—and which parties use it. Configurable, granular consent management covering both members and their personal representatives is critical. Likewise, ongoing enhancements to how third-party applications are vetted will be critical to maintaining appropriate security and privacy policies.

Keep Future Compliance Needs In Mind: Payers need to meet CMS 9115-F requirements while considering CMS 9915-F and CMS 9123-F regulations as well as future interoperability requirements. A holistic CMS compliance approach needs to adapt to anticipated changes (i.e., CMS 9115-F payer-to-payer data exchange evolving to CMS 9123-F payer-to-payer API.

Innovaccer: Your partner for compliance and interoperability

Innovaccer has partnered with large payer organizations like Blue Cross Blue Shield of Arizona (BCBSAZ) to improve interoperability and data access for members. By solving data quality and aggregation challenges and offering appropriate access to healthcare data through Patient Access and Provider Directory APIs, Innovaccer helps organizations go beyond meeting short-term compliance requirements.

"We're excited to partner with Innovaccer to increase control of—and access to—healthcare data through interoperability using the Innovaccer Health Cloud," said Michael Pencek, Chief Information Officer at BCBSAZ.

Innovaccer's technology can help you implement holistic CMS compliance strategies. Our approach leverages the scalable Innovaccer Health Cloud to help you meet interoperability requirements and improve care outcomes, no matter where you are in your journey. We're committed to enabling a more digitally connected healthcare ecosystem while working toward our mission to help healthcare care as one.

Learn more about Innovaccer's CMS Compliance solution.

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