By Adam Turteltaub

Healthcare lives on data. Getting it to the patient and providers is essential for delivering quality care, but that can be a challenge.

As Eden Avraham-Katz (LinkedIn), Vice President, Legal and Compliance at 1upHealth explains in this podcast, the CMS Interoperability and Prior Authorization Rule helps standardize how health plans and payers share information with individuals, in-network providers and other providers as well. Animating the rules is the goal of empowering the individual with relevant information so that they can make better, more informed decisions as well as benefit from more affordable care.

Complying with the rule will require the development of multiple APIs to ensure data moves smoothly. To further ease the flow, the Fast Healthcare Interoperability Resources (FHIR) standard has emerged for structuring data, which helps ensure an accurate transfer.

To ensure your organization meets its compliance obligations, she recommends beginning at once. You’ll need APIs to facilitate patient, provider and payer access plus another one for handling prior authorizations.

You will also need to focus on your opt-in/opt-out process. Listen in to learn more about how best to address these issues and others to ensure compliance with the Interoperability and Prior Authorization Rule.

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