API-Driven Claims Adjudication, Brought to you By 21st Century Cures

Would this project have been done without the 21st Century Cures Act?

FTA
Anthem, Humana and SS&C Technologies have entered into a joint venture named DomaniRx to develop a claims adjudication and pharmacy benefits manager cloud platform, according to documents filed by SS&C Technologies with the Securities and Exchange Commission.

PBMs receive and store massive amounts of data in their function of claims adjudication. The use of an Application Programming Interface, or API, allows applications to talk to each other for a faster, seamless process.
In December 2020, CMS proposed the Interoperability and Patient Access final rule, which became final on May 1. It is aimed at removing silos of information that prevent patient data exchange and promotes interoperability throughout the healthcare system.
Starting July 1, payers were required to give patients access to their data through "open" APIs, subject to the provision of HIPAA. Medicaid, CHIP and individual market Qualified Health Plans payers needed to build, implement and maintain APIs that enabled provider access to their patients' data. They were also required to streamline the prior authorization process.
AHIP pushed back against the rule earlier this year, saying it was hastily constructed, requiring insurers to build these technologies without the necessary instructions.

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I don't imagine it would have, but I'm curious what you think.

#healthcare #healthIT #cio #cmio #chime #himss

https://www.healthcarefinancenews.com/news/anthem-and-humana-enter-multi-million-agreement-ssc-api-cloud-platform

Would this project have been done without the 21st Century Cures Act?

FTA
Anthem, Humana and SS&C Technologies have entered into a joint venture named DomaniRx to develop a claims adjudication and pharmacy benefits manager cloud platform, according to documents filed by SS&C Technologies with the Securities and Exchange Commission.

PBMs receive and store massive amounts of data in their function of claims adjudication. The use of an Application Programming Interface, or API, allows applications to talk to each other for a faster, seamless process.

In December 2020, CMS proposed the Interoperability and Patient Access final rule, which became final on May 1. It is aimed at removing silos of information that prevent patient data exchange and promotes interoperability throughout the healthcare system.

Starting July 1, payers were required to give patients access to their data through "open" APIs, subject to the provision of HIPAA. Medicaid, CHIP and individual market Qualified Health Plans payers needed to build, implement and maintain APIs that enabled provider access to their patients' data. They were also required to streamline the prior authorization process.

AHIP pushed back against the rule earlier this year, saying it was hastily constructed, requiring insurers to build these technologies without the necessary instructions.

-----

I don't imagine it would have, but I'm curious what you think.

#healthcare #healthIT #cio #cmio #chime #himss

https://www.healthcarefinancenews.com/news/anthem-and-humana-enter-multi-million-agreement-ssc-api-cloud-platform