Patient Access API
Real-time access clinical, formulary, explanation of benefits, and prior authorization data for members to facilitate transparency and drive informed decision-making.
The most recent CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) is a mandate with significant regulatory compliance requirements. Building from the foundation of CMS-9115-F, CMS-0057-F accelerates the shift to broader adoption of FHIR APIs to enable seamless access and exchange of interoperable healthcare data.
Built on Abacus Insights’ usable data platform for payers and fully integrated with Onyx’s CMS interoperability platform, our CMS Interoperability data solution helps payers achieve regulatory compliance seamlessly, efficiently, and cost-effectively while building a strategic foundation of truly interoperable healthcare data.
Real-time access clinical, formulary, explanation of benefits, and prior authorization data for members to facilitate transparency and drive informed decision-making.
Bulk exchange of claims and clinical data with in-network providers via EHRs to facilitate care coordination and burden reduction for providers.
Ability to electronically exchange claims and clinical data between payers when members switch health plans.
Support providers’ submission of prior authorization requests from their EHR/EMR while enabling your utilization management ecosystem to consume electronic prior authorization requests and make determinations within defined turnaround times.
We meet you wherever you are on your CMS Interop compliance journey.
Existing contract with CMS9115 vendor – Abacus can implement the CMS0057 APIs and Metrics and drive efficiencies between the two solutions
Not yet live with CMS-9115-F or switching vendors – Accelerated migration/implementation of a patient access solution to meet CMS January 1, 2026 reporting requirements and reduce the burden of rework required to make available additional patient data and information as required under CMS-0057-F
Have your own plan to meet requirements for electronic prior auth (ePA) – We can provide only the ePA metrics and/or routing capabilities while deploying the CMS-0057-F modules for patient access, provider access, and payer-to-payer interoperability
We deploy on AWS and Azure, in our cloud or yours, providing flexibility and greater control over your CMS Interoperability integration plan and schedule.
Transparent, governed, normalized and standardized claims and clinical data models provide the foundation for an enterprise ecosystem of data assets that can be transformed and enriched to support business use beyond compliance, including in key areas such as quality, value-based care, risk adjustment, and building a longitudinal member record.
HITRUST r2-certifed and SOC 2-certified with compliance and data security built into every layer of the Abacus platform, designed to protect your members’ data, keep you compliant, and provide peace of mind.
Choose Abacus because our CMS Interoperability data solution delivers much more than regulatory compliance: It’s a strategic investment in your interoperability data strategy as the foundation for driving improved experience, outcomes, and performance across the healthcare ecosystem.
Contact us today to start working on your CMS Interoperability compliance plan.
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