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CMS Payer Interoperability 2022
An Early Look at Purchase Decisions and Vendor Performance in a New Market

author - Joe VanDeGraaff
Joe VanDeGraaff
author - Jennifer Hickenlooper
Jennifer Hickenlooper
author - Ruirui Sun
Ruirui Sun
September 13, 2022 | Read Time: 15  minutes

CMS recently issued a new regulation stipulating that CMS-regulated payers must be able to securely store and share patient data under the HL7 FHIR standard. To achieve this, organizations use CMS payer interoperability products, which usually provide capabilities such as patient access APIs, provider directory APIs, and payer-to-payer data exchange. Health plans and state agencies are evaluating how well technology vendors’ existing or newly developed solutions can help them stay compliant with the new CMS requirements. This report is KLAS’ first to validate the purchase decisions and customer experience of some of the vendors in this area.

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Key Findings:

  1. 1upHealth, Edifecs, and Smile CDR See Strong Early Traction
  2. Cognizant and Change Healthcare Already Up for Replacement
  3. Provider-Sponsored Health Plans Often See InterSystems & Epic as Viable Choices
  4. Early Performance Insights: 1upHealth Customers Highlight CMS Expertise & Smile CDR Customers Satisfied with Technology; Respondents across All Vendors Experience Bumpy Implementations
author - Sarah Hanson
Sarah Hanson
author - Madison Moniz
Madison Moniz
author - Andrew Wright
Project Manager
Andrew Wright
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.