Interoperability for CMS Compliance

MedicaSoft offers impacted payers a simple technical solution for compliance with CMS Interoperability mandates. MedicaSoft’s solution for CMS Interoperability:

• Supports all technical requirements for CMS-0057-F

• Integrates easily with data warehouse and ancillary services

• Is a modular, scalable solution that adapts easily to future CMS mandates

 At a high level, for each of the CMS Interop APIs, implementation is three phases:

1 - Map: Mapping data from internal systems to FHIR for applicable members

2 - Connect: Connecting Ancillary Services (authentication, analytics, etc.)

3 - Schedule: Setting and scheduling data refresh (Payer Data → FHIR Data)

During implementation of the technical solution, these three phases of work are completed in parallel.  (1) Mapping is typically the phase of the implementation that takes the most time and requires the highest level of effort.

Figure 1: Technical Solution Diagram

Why MedicaSoft?

• FHIR Platform in production since 2017

• More than Eight Years of Enterprise FHIR Platform Experience

• Proven Platform that serves as interop infrastructure for multiple state HIEs

• Intimately familiar with the mapping, matching, and quality challenges

• Modular, scalable solution that’s readily adaptable to customer processes

• Open, standards-based solution that’s readily adaptable to future CMS mandates

• Specialized tools to accelerate mapping of payer’s data to FHIR

• Mature API Documentation

• HITRUST Security

For Medicaid

• Experience with CMS Interop Implementations in State Medicaid Agencies

• Knowledgeable of CMS-required Processes for Security, Project Management

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