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CMS Payer Interoperability

Software designed to meet requirements for CMS-regulated payers and state agencies by providing a patient access API, provider directory API, and payer-to-payer data exchange.

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Benjamin Cassity
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KLAS Research Director - Benjamin Cassity
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Latest Related Report

CMS Payer Interoperability 2025: Which Vendors Are Payers Relying on to Meet Changing CMS Mandates?) Report Cover Image
Performance
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CMS Payer Interoperability 2025: Which Vendors Are Payers Relying on to Meet Changing CMS Mandates?
24 October 25
Payer organizations depend on expertise and guidance from their vendor partners to meet continually evolving federal mandates, including the upcoming CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), which will partially take effect in January 2026. Amid these changes, many payers are reevaluating their interoperability strategies and seeking long-term partners that can not only help them meet CMS mandates but also drive deeper value. This report examines how well vendors deliver CMS interoperability solutions and how well they support customers with proactive guidance; additionally, the report looks at which vendors are top of mind as payers anticipate meeting CMS-0057-F and other mandates.

Report Abstract

Key Findings:

  1. 1upHealth Seen as a Long-Term Partner Thanks to Subject Matter Expertise & Strong Relationships; Clients of Edifecs Say Vendor Is Part of Future Plans but Want More Consistent Support
  2. Onyx Technology Highlighted for Delivering Needed Technology, Smile Digital Health for Influencing FHIR Standards; Customers of Both Looking for More Proactive Guidance
  3. 1upHealth, Onyx Technology & Smile Digital Health Have the Most Mindshare for Future CMS Interoperability Work; Epic, Google & AWS Noted for Strength with Integration & the Cloud
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Performance Data

Overall Score by Product

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Products Appearing in Decisions

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Overall Score by Question Topic

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Provider Facility Size by Product

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Provider Facility Type by Product

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Current Time Inside Cache Tag Helper: 12/4/2025 2:58:46 PM and Model.SegmentId = 445
Related ReportsView All Reports
Performance
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Cognizant Payer Solutions 2025
25 November 25    |   Boyd Stewart and Jennifer Hickenlooper
Cognizant has long been a major player in payer technology, with offerings that span core administration, care management, quality/reporting, and pricing/payment analytics, along with a range of consulting and business processing services. Some health plans use a single solution from Cognizant, but others are deep adopters: i.e., long-standing clients that leverage multiple Cognizant offerings across their organizations. For this report, KLAS spoke with six vendor-identified deep adopters to learn (1) how they are using Cognizant’s offerings, (2) what their experience has been with the vendor, and (3) what benefits they have realized from their deep adoption.
Point of Light
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Points of Light 2023 Case Study 2
12 April 23    |   Aurene Wilford and Boyd Stewart
Prior authorizations for referrals and clinical procedures are widely acknowledged as a significant pain point for all involved parties—payers, providers, and patients. Using implementation guides from HL7’s Da Vinci Project, the collaborators in this case study created bidirectional data exchange through a FHIR API that enables an automated, in-workflow authorization process. The pilot use cases have been successful, achieving improved efficiency, reduced costs, and—most critically—more timely care and improved patient outcomes.



Reducing Filters

Unlike sizing filters, reducing filters DO NOT recalculate scores based on the evaluations that meet these requirements. They narrow the list of solutions to show the vendors and solutions that can meet a specific need.

This data is based on interviews with a sample of the firms' recent clients. As a result, it is not necessarily comprehensive of all work a firm may do in this segment.

We require a minimum of 2 confirmations of a service performed in the last 3 years for a solution to qualify.

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