Health Plan Solutions

Improve member engagement, innovate new business models, and meet the CMS mandates.

Comply with CMS Regs

Provide members with benefit information electronically, on demand, as required by CMS.

Engage Members

Embed the OnyxOS API in your client portal and provide up-to-date information about each member’s care & benefits.

Innovate & Accelerate Business

Use data in innovative new ways with expanding ecosystem of health IT and business apps.

Health plans are required to provide a FHIR-based API to deliver information to patients.

OnyxOS MAKES IT EASY!

  • Payer to Payer
  • Qualified Health Plan
  • Medicare Advantage Organization
  • Medicaid Fee-For-Service Program
  • CHIP FFS Program
  • Medicaid Managed Care Plan
  • CHIP Managed Care Entity
Onyx, SAFHIR, and CMS

CMS Interoperability Final Rule: Payer Requirements

CMS Policy

Patient Access APIs

FHIR API to share following data with members:

Patient Data

  • Adjudicated Claims
  • Provider Remittances
  • Enrollee Cost Sharing
  • Encounters
  • Clinical Data
  • Formulary Data

Compliance Deadline

January 1, 2021

CMS Policy

Provider Directory API

FHIR-based API to make following provider directory info available:

Patient Data

  • Provider Names
  • Address
  • Phone Number
  • Specialties
  • Pharmacy Directory

Compliance Deadline

January 1, 2021

CMS Policy

Payer-to-Payer Data Exchange

Send & receive patient data at request of members using common data classes and data elements from USCDI, including:

Patient Data

  • Allergies & Immunizations
  • Problems/Procedures
  • Care Team Members
  • Clinical Notes/Goals
  • Medications/Vitals
  • Etc.

Compliance Deadline

January 1, 2022

From CMS’ Best Practices for Payers and App Developers

“CMS released the Interoperability and Patient Access final rule on March 9, 2020. This final rule requires most CMS-regulated payers to implement and maintain a secure, standards-based Patient Access Application Programming Interface (API) (using Health Level 7® (HL7) Fast Healthcare Interoperability Resources® (FHIR) Release 4.0.1) that allows patients to easily access their claims and encounter information, including cost (specifically provider remittances and enrollee cost-sharing), as well as a defined sub-set of their clinical information through third-party applications of their choice.”

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Modeled on the Technology at the Heart of the CMS Blue Button 2.0 API

The Blue Button 2.0 API is central to CMS’ new interoperability regulations. CMS requires health plans to provide information to patients in the same way the agency does through Blue Button 2.0.

NewWave, Onyx’s parent company, built the Blue Button 2.0 API for CMS, supporting more than 60 million Americans. Onyx transformed the Blue Button 2.0 offering into OnyxOS to provide the same capabilities to industry and other federal agencies. This translates into benefits for you!

  • Guaranteed compliance with federal regulations
  • Massively scalable (built on Microsoft Azure)
  • Security and consent management out of the box
  • Capabilities to ingest various data formats

Some of the large Blue plans and sizable commercial health plans already deploy OnyxOS to meet their requirement for FHIR-based data interoperability.

OnyxOS transforms the data you already have into actionable information to power your products and services.

Onyx Technology LLC is a healthcare interoperability solutions provider.

Disclaimer

FHIR® is the registered trademark of HL7 and is used with the permission of HL7.

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