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Provider Directory APIs: Beyond a Compliance-Only Mindset

State of Payer Compliance on Provider Directory APIs It has been 18 months since the July 2021 effective date of the CMS Final Rule on Patient Access and Interoperability. In January 2022, we had identified Provider Directory APIs from 128 payers. Since then, we observed 78 additional payers publishing Provider Directory APIs. The addition of …

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Responses to the CMS RFI on National Healthcare Directory

In response to CMS’s RFI on a National Healthcare Directory (responses were due Thurs 12/6/2022), over 600 responses were submitted (around 50% of these were part of two major cut/paste campaigns, making the responses difficult to navigate on Regulations.gov). We reviewed and summarized the responses by industry segment. We also excerpted statements and linked to …

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A Review of the CMS RFI on National Healthcare Directory

Executive Summary: CMS describes a National Healthcare Directory that will streamline provider data collection and promote interoperability. Years of industry engagement have produced layers of additional use cases. CMS should consider focusing on foundational data and not prematurely adding scope until it has established a complete, accurate provider demographic data set. CMS should also consider …

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Health equity and languages spoken

The Need for Linguistically-Appropriate Services On April 20, 2022, CMS released an action plan that establishes health equity as a ‘first pillar’ of its strategic vision under the Biden-Harris Administration. Included in its priorities are two actions that consider languages spoken: Promote culturally and linguistically appropriate services to ensure understandable and respectful care and services …

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The Importance of Health Plan Information and Identity

Defacto Health has been reviewing health insurers’ Provider Directory APIs in terms of availability, issues, and use cases for almost a year now. This post is a continuation, and we are focusing on the importance of health plan information within the APIs. While many exchanges between patients and providers about insurance stop short at “Do …

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Using Provider Directory APIs to assess provider network size

When CMS issued its requirement for payers to publish Provider Directory APIs, it contemplated use cases such as in-network provider search and health plan shopping. Consumers shopping for health plans want to check whether their preferred providers are in-network, but they are also likely interested in the robustness of the network. Carriers may lever up …

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Analysis of top 50 payers’ Provider Directory APIs

In our previous post, we reviewed aggregate statistics on payers publishing provider directory APIs in the first six months of enforcement of the CMS Final Rule. In this post, we will look in more detail at the top 50 payers and understand and compare their processes around API access, registration (if required), issue reporting, and …

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Payer Compliance: Provider Directory APIs in the first six months since CMS Final Rule enforcement

The CMS Final Rule on Interoperability and Patient Access requires payers to publish provider directory APIs and has been enforceable since July 1, 2021. CMS issued the rule to increase provider network transparency and to encourage third-party developers to leverage machine-readable provider network data from payers to develop new experiences around in-network provider search, health …

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What indoor healthcare wayfinding taught me about the governance of practice location data

With the convergence of payer and provider interoperability, there is growing interest in how data sourced directly from EHRs could support provider search and patient access use cases. Providers have for some time been working towards using EHRs (and adjacent credentialing systems) to support their own provider search tools. Recent partnerships (Epic/Mapquest and AllScripts/ZocDoc) demonstrate …

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Epic partners with Mapquest: EHR and location awareness

Last week, Epic announced it is partnering with Mapquest to ‘enable location services within its EHR system’. Three questions come to mind immediately: First, what in the world is Mapquest doing these days? Second, how is Epic thinking about incorporating location into its EHR workflows? Finally, does it mean that we can begin expecting EHRs …

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