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CMS Payer Interoperability 2025
Which Vendors Are Payers Relying on to Meet Changing CMS Mandates?
Author
Benjamin Cassity
Author
Jennifer Hickenlooper
Author
Maddie Calder
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.
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Key Findings:
- 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
- Onyx Technology Highlighted for Delivering Needed Technology, Smile Digital Health for Influencing FHIR Standards; Customers of Both Looking for More Proactive Guidance
- 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
Writer
Natalie Hopkins
Designer
Natalie Jamison
Project Manager
Andrew Wright
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. © 2025 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.