The Road to Interoperability Series: Payer to Payer API

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