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Addressing Regulatory Compliance for Health Insurers

InterSystems Payer Services

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A Robust Solution to the CMS Interoperability Mandates

To address the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) as well as the older CMS Interoperability and Patient Access Final Rule (CMS-9115-F), InterSystems is updating our product offerings to include InterSystems Payer Services, a suite of services designed to maximize your data infrastructure investment options. Together with HealthShare Unified Care Record®, they offer robust and comprehensive capabilities for regulatory compliance and more. You can choose the package that best fits your immediate needs and add others as you are ready. InterSystems Payer Services replace the HealthShare CMS Solution Pack.

Whether your organization views these mandates as a burden to be shouldered, or a strategic investment to be embraced, InterSystems Payer Services offer a path to operational value and a foundation on which to build toward market leadership, all while supporting your compliance and value-based care journey.

Addressing Requirements to Publish APIs

CMS interoperability mandates include a requirement for payers to publish their APIs on their website. For those organizations that have implemented the HealthShare CMS Solution Pack, the relevant documentation is below:

  • Patient Access APIs – Giving patients access to their own claims, clinical, and pharmacy benefit information (2021) - API Documentation
  • Provider Directory APIs – Online provider and pharmacy directory access (2021) - API Documentation

InterSystems Payer Solutions currently is available for use by customers in the United States only.

Related Product Information

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