Summary of the FHIR-based Provider Directory CMS Interoperability Rule
Understand the compliance requirements and find the key deadline to comply to the CMS mandated Provider Directory API Policy
CMS regulated health plans must make a Provider Directory by implementing a FHIR-based API that is publicly available on their website.
In a nutshell:
The challenge is that, currently, health systems are not built to enable interoperability and data exchange between payers.
Lack of seamless data exchange in healthcare has historically detracted from patient care, leading to poor health outcomes, and higher costs.
Provider Directory API endeavours to:
Enable patient access to in-network provider and drug formulary information
Improve interoperability and care coordination across providers
Promote transparency and care continuity
All while reducing burden and costs on payers and providers.
CMS-regulated payers, like:
Medicare Advantage (MA)
Medicaid Managed Care Organizations
Children’s Health Insurance Programs (CHIP)
The Provider Directory API is being introduced across the U.S. because it enables:
Provider burden reduction
All health plans must comply with the CMS Provider Directory API by the 1st of July, 2021.