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The Road to Interoperability Series: Payer to Payer API

February 8, 2024 1:30 PM - 3:30 PM (EST)

Description

Through the provisions in the CMS Interoperability and Prior Authorization Final Rule, Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs), (collectively “impacted payers”) are required to implement and maintain certain Health Level 7® (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) application programming interfaces (APIs) to improve the electronic exchange of health care data, as well as to streamline prior authorization processes

To support care continuity, CMS is requiring that impacted payers implement and maintain a Payer-to-Payer API to make available claims and encounter data (excluding provider remittances and enrollee cost-sharing information), data classes and data elements in the USCDI and information about certain prior authorizations (excluding those for drugs). Impacted payers are only required to share patient data with a date of service within five years of the request for data. This will help improve care continuity when a patient changes payers and ensure that patients have continued access to the most relevant data in their records.

As part of WEDI's Road to Interoperability and Prior Authorization Educational Series, we invite you to register for our Payer to Payer event as we discuss key elements of the Payer to Payer API and host an expert panel who will discuss best practices, challenges and more.

Today's Participants:

Ferris Taylor (moderator), Executive Director, HCEG
Mark Scrimshire, Chief Interoperability Officer, Onyx Technology
Danielle Lloyd, MPH, SVP, Private Market Innovation & Quality Initiatives, AHIP
Ron Wampler, Executive Director, Interoperability, Aetna, a CVS Health Company
Michael Gould, Associate Vice President, Interoperability Strategy, ZeOmega
Karuna Relwani, Business Interoperability Lead, Health Information Technology, Blue Cross Blue Shield Association
Richard Abercrombie, Lead Developer, Blue Cross Blue Shield of South Carolina
John Roszkowiak, Director, EDI/Encounter/Interoperability, Support Operations and Quality Assurance, San Francisco Health Plan
Dennis Zuzek, Senior Vice President and Chief Technology Officer, HealthPartners
Artem Sopin, Senior Product Manager, Edifecs

Pricing

Free for WEDI members

$199 for Non Members

Or attend all 7 educational events related to "The Road to Interoperability and Prior Authorization" series for $999 through the Bundle available on the WEDI Event Calendar.

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Contact Information

WEDI
Name: Michael McNutt
Email: mmcnutt@wedi.org
Details: To learn about WEDI membership benefits, contact Bill Allder, ballder@wedi.org

Free to the WEDI membership. Non-members can attend this session for $199 OR can purchase all 7 virtual spotlights for $999. See the Bundle Registration on the WEDI event calendar

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The Road to Interoperability Series: Payer to Payer API

February 8, 2024 1:30 PM - 3:30 PM (EST)

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The Road to Interoperability Series: Payer to Payer API

February 8, 2024 1:30 PM - 3:30 PM (EST)

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