Beginning in 2021, payers must make individual claims and clinical data available to enrollees through open APIs using the Fast Healthcare Interoperability Resources (FHIR) standard. Patient clinical data will need to align with the United States Core Data for Interoperability (USCDI) standard, which contains data elements new to health plans.
In addition, a new federal ban on information blocking will also be imposed early in 2021, carrying significant monetary penalties for covered entities found to be improperly withholding legally requested health data.
Though the compliance deadlines were recently extended due to COVID-19, forward-thinking payers need to take steps now to build a strong data governance strategy that takes into consideration process, technology, and personnel.
Preparing for compliance with the new rules will involve multiple departments across payer organizations, many of which rely on the same data. The solution lies in plans rethinking their data strategy and new ways to collect, normalize, manage, and share patient health data.
Watch our ONC/CMS interoperability webinar on-demand to learn:
- An overview of the regulations and compliance timeline.
- Impact on payers of the finalized federal regulations that address interoperability of health data, new application programming interface (API) standards, and a ban on information blocking.
- Strategies and solutions payers can adopt to optimize their data management while complying with the new rules.
- Payer organizations understand too well that creating a true single source of truth for their data will be business-critical going forward and, in many cases, are turning to trusted third parties to ensure a timely implementation.
- Cheryl Mason - Director, Content and Informatics, Health Language, Wolters Kluwer
- Bob Hussey - Founder & Principal, RGH Health Consulting, LLC