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CMS Payer Interoperability CMS Payer Interoperability
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CMS Payer Interoperability
2022 Vendor Guide

author - Joe VanDeGraaff
Author
Joe VanDeGraaff
author - Jennifer Hickenlooper
Author
Jennifer Hickenlooper
author - Ruirui Sun
Author
Ruirui Sun
 
August 4, 2022 | Read Time: 5  minutes

Current Time Inside Cache Tag Helper: 10/2/2022 7:40:09 PM and Model.reportId = 2957

To enable patients to securely transfer their data from payer to payer as their coverage changes, new mandates dictate that CMS-regulated payers must be able to securely exchange patient data. Several technology vendors are available to help health plans and state agencies comply with these interoperability requirements, providing capabilities such as patient access APIs, provider directory APIs, and payer-to-payer data exchange. This vendor guide is intended to help health plans and TPAs understand the vendor technology options; it includes those vendors known to KLAS as of July 2022.

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Overview of CMS Payer Interoperability Vendors

Below are brief summaries of how each vendor currently positions their payer interoperability solutions for the US market. The summaries are based on vendor-provided and publicly available information and do not include any KLAS-validated performance data. Research into the customer experience and payers’ purchasing decisions is currently ongoing and is scheduled to publish in fall 2022.

legend

Vendor profiles

AaNeelCare overview

1upHealth FHIR Platform: Vendor focuses on end-to-end FHIR data capabilities. Solutions are cloud based and provide machine learning-enabled analytics. Vendor believes they offer the most complete FHIR data platform in the cloud to help customers meet their data strategies and CMS compliance needs. Vendor indicates they serve more than 60 customer organizations.

AaNeelCare overview

AaNeel AaNeelCare: Product is designed to be used by ACOs, TPAs, payers, and provider organizations. Product is web based and is customizable without requiring installations or downloads. Product is said to come with 14 preset modules and can be used for further customizations.

change healthcare overview

Change Healthcare Connected Consumer Health Interoperability Solutions: Vendor offers two solutions: one is free and provides rapid data access to meet CMS deadlines, and the other is said to be a turnkey solution. Both are part of Change Healthcare’s member engagement segment, which is intended to expand payer-to-member interactions.

cognizant overview

Cognizant Interoperability Solutions: As part of the TriZetto product line, the interoperability solutions include a SaaS offering, data management, and consulting services. The products are said to integrate with Facets and QNXT. Vendor aims to help clients identify business priorities, develop strategies, track proposed and amended regulation scenarios, and streamline access for patients.

edifecs overview

Edifecs XEngine Server For FHIR: Vendor’s expertise and relationship with the HL7 Da Vinci Project are positioned as key differentiators for their FHIR solutions and resources. Vendor reports that the product’s configuration capabilities can easily fit clients’ needs while being seamlessly integrated into existing back-end systems and workflows.

epic overview

Epic Tapestry: Epic’s offering for CMS payer interoperability is considered part of Tapestry, the core claims engine used by provider-owned health plans. Vendor positions their capabilities as connecting health plans, providers, and members and facilitating the exchange of clinical data.

health catalyst overview

Health Catalyst Analytics Platform: Vendor offers a data and analytics platform for providers and has expanded service to the payer and HIE markets. Vendor offers various payer interoperability products, focusing on clinical and claims data integration. The clinical messaging solution is featured specifically for the provider directory.

healthlx overview

HealthLX Core Interoperability Platform: Vendor describes the product as a real-time data exchange solution for driving complex clinical data workflows, such as those for SDOH, and standards-based FHIR workflows. Vendor offers hosted, hybrid, and on-premises deployment options. Implementation services claimed to be rapid and cost effective.

health samurai overview

Health Samurai Aidbox: Product can be deployed side by side with health plans’ existing solutions, including cloud or on-premises solutions, or can be hosted by Health Samurai. Vendor says the solution integrates into existing data flows and aggregates all the data required to be made available through the FHIR API.

innovaccer overview

Innovaccer CMS Compliance Solution: Vendor offers a cloud-based solution that is positioned as being compatible with Microsoft Azure and Amazon Web Services. In addition to helping customers be CMS compliant, vendor provides end-to-end assistance to both payers and members. Product runs patient authorization processes and consents.

inovalon overview

Inovalon Consumer Health Gateway: Vendor describes product as secure solution to provide members with quick, reliable access to their health data. Part of the Inovalon ONE Platform, the product is said to be HITRUST certified and built with real-time APIs and to deliver patient claims and clinical data via FHIR-based data exchange.

intersystems healthshare overview

InterSystems HealthShare CMS Solution Pack: Solution is positioned as a turnkey solution that is part of the vendor’s HealthShare product line. Intended customers are both payers and provider organizations. Use cases include patient access APIs, a provider directory API, payer-to-payer data exchange, and support for HEDIS reporting and risk adjustment.

onyx overview

Onyx SAFHIR: Vendor’s parent company, NewWave, collaborated with CMS to build the Blue Button 2.0 API, which SAFHIR is modeled on. Onyx reports the product provides a full FHIR interoperability solution in Microsoft Azure. Onyx also released movemyhealthdata.com, said to be the first payer-to-payer exchange solution, connecting over 250 health plans.

sagitec overview

Sagitec HealFHIR: Vendor serves multiple industries and in healthcare payer space focuses primarily on MCOs. Product is a PaaS platform; it is reported to cost 5 cents per member per month and to take 100 days to deploy. Vendor offers a trial environment for payers using the payers’ provider and pharmacy directory data.

smile cdr overview

Smile CDR: Vendor reports their solution is used by 4 of the 10 largest payers in the US, among others. Vendor sees deep horizontal scaling via containers as one of their key differentiators. Vendor is the first to receive certification showing compliance with the CMS Interoperability and Patient Access final rule (CMS-9115-F).

zeomega overview

ZeOmega HealthUnity: Vendor reports their product meets and exceeds the highest industry-defined requirements for data exchange and information security, citing its passing of three data security and interoperability testing programs. Product is said to integrate with existing payer and EMR systems and to have prebuilt adapters for vendor’s Jiva system.

zyter overview

Zyter CMS Interoperability Solution: Vendor claims to offer out-of-the-box cloud-based solution that works with disparate systems across any enterprise and supports multiple communication types. Vendor acquired Casenet in 2021 and targets their payer products to commercial, government, and third-party lines of business.

Current Time Inside Cache Tag Helper: 10/2/2022 7:40:09 PM and Model.reportId = 2957

Overview of CMS Payer Interoperability Vendors

Below are brief summaries of how each vendor currently positions their payer interoperability solutions for the US market. The summaries are based on vendor-provided and publicly available information and do not include any KLAS-validated performance data. Research into the customer experience and payers’ purchasing decisions is currently ongoing and is scheduled to publish in fall 2022.

legend

Vendor profiles

AaNeelCare overview

1upHealth FHIR Platform: Vendor focuses on end-to-end FHIR data capabilities. Solutions are cloud based and provide machine learning-enabled analytics. Vendor believes they offer the most complete FHIR data platform in the cloud to help customers meet their data strategies and CMS compliance needs. Vendor indicates they serve more than 60 customer organizations.

AaNeelCare overview

AaNeel AaNeelCare: Product is designed to be used by ACOs, TPAs, payers, and provider organizations. Product is web based and is customizable without requiring installations or downloads. Product is said to come with 14 preset modules and can be used for further customizations.

change healthcare overview

Change Healthcare Connected Consumer Health Interoperability Solutions: Vendor offers two solutions: one is free and provides rapid data access to meet CMS deadlines, and the other is said to be a turnkey solution. Both are part of Change Healthcare’s member engagement segment, which is intended to expand payer-to-member interactions.

cognizant overview

Cognizant Interoperability Solutions: As part of the TriZetto product line, the interoperability solutions include a SaaS offering, data management, and consulting services. The products are said to integrate with Facets and QNXT. Vendor aims to help clients identify business priorities, develop strategies, track proposed and amended regulation scenarios, and streamline access for patients.

edifecs overview

Edifecs XEngine Server For FHIR: Vendor’s expertise and relationship with the HL7 Da Vinci Project are positioned as key differentiators for their FHIR solutions and resources. Vendor reports that the product’s configuration capabilities can easily fit clients’ needs while being seamlessly integrated into existing back-end systems and workflows.

epic overview

Epic Tapestry: Epic’s offering for CMS payer interoperability is considered part of Tapestry, the core claims engine used by provider-owned health plans. Vendor positions their capabilities as connecting health plans, providers, and members and facilitating the exchange of clinical data.

health catalyst overview

Health Catalyst Analytics Platform: Vendor offers a data and analytics platform for providers and has expanded service to the payer and HIE markets. Vendor offers various payer interoperability products, focusing on clinical and claims data integration. The clinical messaging solution is featured specifically for the provider directory.

healthlx overview

HealthLX Core Interoperability Platform: Vendor describes the product as a real-time data exchange solution for driving complex clinical data workflows, such as those for SDOH, and standards-based FHIR workflows. Vendor offers hosted, hybrid, and on-premises deployment options. Implementation services claimed to be rapid and cost effective.

health samurai overview

Health Samurai Aidbox: Product can be deployed side by side with health plans’ existing solutions, including cloud or on-premises solutions, or can be hosted by Health Samurai. Vendor says the solution integrates into existing data flows and aggregates all the data required to be made available through the FHIR API.

innovaccer overview

Innovaccer CMS Compliance Solution: Vendor offers a cloud-based solution that is positioned as being compatible with Microsoft Azure and Amazon Web Services. In addition to helping customers be CMS compliant, vendor provides end-to-end assistance to both payers and members. Product runs patient authorization processes and consents.

inovalon overview

Inovalon Consumer Health Gateway: Vendor describes product as secure solution to provide members with quick, reliable access to their health data. Part of the Inovalon ONE Platform, the product is said to be HITRUST certified and built with real-time APIs and to deliver patient claims and clinical data via FHIR-based data exchange.

intersystems healthshare overview

InterSystems HealthShare CMS Solution Pack: Solution is positioned as a turnkey solution that is part of the vendor’s HealthShare product line. Intended customers are both payers and provider organizations. Use cases include patient access APIs, a provider directory API, payer-to-payer data exchange, and support for HEDIS reporting and risk adjustment.

onyx overview

Onyx SAFHIR: Vendor’s parent company, NewWave, collaborated with CMS to build the Blue Button 2.0 API, which SAFHIR is modeled on. Onyx reports the product provides a full FHIR interoperability solution in Microsoft Azure. Onyx also released movemyhealthdata.com, said to be the first payer-to-payer exchange solution, connecting over 250 health plans.

sagitec overview

Sagitec HealFHIR: Vendor serves multiple industries and in healthcare payer space focuses primarily on MCOs. Product is a PaaS platform; it is reported to cost 5 cents per member per month and to take 100 days to deploy. Vendor offers a trial environment for payers using the payers’ provider and pharmacy directory data.

smile cdr overview

Smile CDR: Vendor reports their solution is used by 4 of the 10 largest payers in the US, among others. Vendor sees deep horizontal scaling via containers as one of their key differentiators. Vendor is the first to receive certification showing compliance with the CMS Interoperability and Patient Access final rule (CMS-9115-F).

zeomega overview

ZeOmega HealthUnity: Vendor reports their product meets and exceeds the highest industry-defined requirements for data exchange and information security, citing its passing of three data security and interoperability testing programs. Product is said to integrate with existing payer and EMR systems and to have prebuilt adapters for vendor’s Jiva system.

zyter overview

Zyter CMS Interoperability Solution: Vendor claims to offer out-of-the-box cloud-based solution that works with disparate systems across any enterprise and supports multiple communication types. Vendor acquired Casenet in 2021 and targets their payer products to commercial, government, and third-party lines of business.

author - Elizabeth Pew
Writer
Elizabeth Pew
author - Breanne Hunter
Designer
Breanne Hunter
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. © 2022 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.