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CMS has released the 21st Century Cures Act rule that affects all CMS-regulated health plans. The first provisions of the rule are coming in effect on January 1, 2021, which is less than ten months from now.
By January 1, 2021, health plans must allow their members to access their claims and encounter information over standards-based secure API (FHIR 4.0.1). Data must be made available no later than one business day after a claim is adjudicated or encounter data are received.
CMS-regulated payers are required to implement and maintain a secure, standards-based (HL7 FHIR Release 4.0.1) API. A solution should allow patients to easily access their claims and encounter information, including cost, as well as a defined subset of their clinical information through third-party applications of their choice.
Encounter data available through the API should contain, at a minimum, all clinical data included in the United States Core Data for Interoperability (USCDI) that is maintained by a health plan.
Data must be made available no later than one (1) business day after a claim is adjudicated or encounter data are received. All the specified data with a date of service on or after January 1, 2016, must be made available.
Here are the key requirements for health plans' Patient Access API:
CMS-regulated health plans are also required to exchange patient claims and encounter data (USCDI) at the patient's request to allow patients to take their information when they are moving from one health plan to another. All the specified data with a date of service on or after January 1, 2016, must be made available for payer-to-payer data exchange.
Payers are required to implement a process for this data exchange beginning January 1, 2022.
Health Samurai is offering health plans a turn-key solution for compliance with the CMS Interoperability and Patient Access rule.
The solution includes:
According to the CMS estimation, the first-year implementation of the API provisions will require a total of 16,800 hours of work per organization at the cost of $1,576,829 per organization. However, Health Samurai's Aidbox implementation will take approximately three months and will dramatically cut the costs and time of development.
Please request a quote today to learn more about our solution for payers.
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