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What payers need to know about CMS Payer-to-Payer Data Exchange requirement
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On December 11, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule designed to improve electronic health care data exchange and streamline the prior authorization process. The CMS fact sheet accompanying the proposed rule stated that its goal is “reducing overall payer and provider burden and improving patient access to health information.”
The proposed rule includes five sets of proposals and five requests for information. The proposals include the following:
Patient Access Application Programming Interface (API) – This proposal builds on the Interoperability and Patient Access final rule, which required certain payers to implement a Fast Healthcare Interoperability Resources-based Patient Access API. CMS would now require these payers to include information about patients’ pending and active prior authorization decisions in the API. These payers would also be required to maintain