Payer Interoperability Solutions

Payer Interoperability Solutions

How a Healthcare-Focused Interoperability Solution Can Help Payers and Health Plans Drive Better Business Decisions

Payers and health plans face a number of data exchange challenges. Bidirectional data exchange between payers’ downstream applications and external trading partners including providers, Health Information Exchanges (HIEs), and members, requires a robust interoperability solution that can:

  • Normalize financial, clinical, and operational data
  • Handle EDI transactions
  • Expedite claims processing and audits
  • Prepare for Healthcare Effectiveness Data and Information Set (HEDIS) reviews
  • Parse all healthcare data standards, including X12, FHIR, HL7, and C-CDA

Benefits of Rhapsody and Corepoint Interoperability Solutions

For Payers

  • Real-time 270-271 eligibility verification
  • Less reliance on data clearing houses
  • Savings from fewer EDIFACT transactions
  • Real-time authorization

For Health Plans, a robust, healthcare-purposed integration engine allows you to gain a greater understanding of your data repository by helping you gather data to:

  • Turn data into insights
  • Handle risk adjustment
  • Identify gaps in care
  • Better analyze quality measures

Compliance with the CMS Interoperability and Patient Access Final Rule

This level of complex data exchange is no longer simply a “nice to have.” It is a matter of compliance for payers and providers.

On March 9, Centers for Medicare and Medicaid Services (CMS) released its much-anticipated final rule on interoperability. The rule mandates that as a condition of participation in Medicare, payers must offer:

  • Payer-provided Directory API
  • Payer-to-Payer Data Exchange
  • Admission, Discharge, and Transfer Event Notifications

The rule specifies the use of HL7 FHIR® for transferring administrative data, such as claims data. Historically, this data has been shared between health plans and providers through different methods.

Healthcare Data Requires Healthcare-Specific Solutions

Achieving this level of payer-provider data exchange requires an interoperability solution designed specifically for healthcare enterprises.

Rhapsody and Corepoint Health interoperability solutions have the robust features that health plans and payers require to securely move data between external trading partners and downstream applications, such as claims management systems, population health systems, and others. Both products were purpose-built for healthcare and have been the most trusted interoperability platforms for healthcare organizations for almost 20 years.

White Paper: The Reality of Healthcare Interoperability:

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