Inside the Onyx CMS-0057 Playbooks
From Mandate to Measurable Value The Interoperability and Prior Authorization Final Rule CMS-0057 is reshaping how payers, providers, and patients exchange health data. It builds on CMS-9115 with expanded use cases, bi-directional APIs, and higher expectations across four tracks: Payer-to-Payer, Provider Access, Patient Access, and electronic Prior Authorization (ePA). Most provisions must be live by […]
Who is Impacted by the Prior Authorization Rule?
Learn who is impacted by the CMS Prior Authorization Rule (CMS-0057)
HLTH is just around the corner
HLTH 2023 is upon us (October 8-11). Let’s meet! There is so much to talk about with the acceleration of the adoption of FHIR for Interoperability.
Not Happy with your CMS Interoperability Platform? There is a solution for that…
The implementation of the CMS Interoperability mandate has proven challenging for many Health Plans. The rule requires publishing a standards-based Patient Access and Provider Directory APIs, and initiating payer-to-payer data exchange. Are you facing issues maintaining your API platform? Is your vendor responsive? Is your current vendor sunsetting their support? You may be considering your […]
What’s the difference between “Patient Access API” and “Provider Access API”?
The latest Proposed rule from CMS addressing Prior Authorization (December 13, 2022) also expands the Patient Access API and adds a Provider API. Provider Access API and Patient Access API are two types of application programming interfaces (APIs) that allow different types of users to access member health information. Both are based on HL7 Fast […]
Prior Authorization: A Business Problem In Need Of Regulation
Prior Authorization: A Business Problem In Need Of Regulation. Regulations must address how providers can discover whether a prior authorization is required and, if required, what information needs to be sent with the request
Is Data Retention on a Collision Course with the CMS Interoperability Rule?
The Data Retention rules for the Legacy systems of Covered Entities may be in conflict with the member data access rules of the CMS Interoperability and Patient Access Rule. Onyx addresses this collision with SAFHIR.