On May 1, 2020, CMS released the Final Interoperability and Patient Access rule listing ways to give patients better access to their health information. This includes the Patient Access API and Provider Directory API policies for Medicare Advantage (MA), Medicaid and CHIP Fee for Service, Medicaid Managed Care Plans, CHIP Managed Care Entities, and Medicare Advantage Prescription Drug Plans (Pharmacy Data Only). The new rule is effective January 1, 2021, however, as a result of COVID-19, and to provide additional flexibility to payers, CMS will not enforce the new requirements until July 1, 2021.
According to CMS, their vision for this project is: “Patients are entitled to access their data, and empowered to be in control of and engaged in their health. This transparency will reduce costs and improve quality by ensuring that the information necessary for healthcare delivery or payment is readily available in a usable format, for anyone entitled to it. And finally, freeing data from locked silos will spur innovation at a pace we have never seen before.”
Sapphire is pleased to announce that we now offer a FHIR 4.0.1-based API to deliver on the Provider Directory API transparency vision for our plan partners.
Generally available now for all participating CareSelect clients, our Basic v1 Provider Finder API offering is based on the DaVinci implementation guide and includes the following mandated elements:
- Medical Providers: Provider directory data on a payer’s network of contracted medical providers, including:
- Provider Names
- Phone numbers
- Pharmacy Providers: (Medicare Advantage organizations that offer Medicare Advantage –Part D plans only) Provider directory data on a payer’s network of contracted pharmacy providers, including:
- Pharmacy Names
- Phone numbers
- # of pharmacies in network
- Type of pharmacy
Also supported are the following requirements:
- Data updated in API within 30 days for changes.
- Link sent to client to access and post the API on their home pages as determined by the plan.
- No restrictions to who can access the API as stated by mandate.
- Basic reporting about the information and number of records and requests received.
For more information about how Sapphire can help your plan meet transparency mandates, contact us at firstname.lastname@example.org.