Health records inform clinical decisions and continuity of care. So when patients move plans, their information must follow in short order. What should be an easy exchange is often complicated by different systems and the requirements to meet evolving government mandates.

Secure transfer of member data from one insurance carrier to another is made simple with the Payer-to-Payer Solution from Smile Digital Health. Plans and providers have rapid access to a member’s comprehensive records, while your organization can focus resources on serving members instead of regulatory changes. And members? They are empowered to actively engage in their health.

Ready. Set. Go beyond.

To support interoperability and meet the constantly evolving regulations governing healthcare data exchange, technology is front and center.

The CMS Patient Access API Final Rule requires that all payers provide members access to their data via a Patient Access API. It is anticipated that Payers will have to comply with a version of the Payer-to-Payer rule (likely based on the 2023 Proposed Rule) within the near future. This rule states that health plans have an interoperable Patient Access API (FHIR recommended) to provide current and former members easy and secure access to the previous five years of their clinical data. And on the horizon is the Proposed Rule, which mandates that payers have the means to initiate, share and transfer clinical records, as well as claims and encounter data, at a member’s request during enrollment via a FHIR-based API.

The Smile Payer-to-Payer Solution offers organizations a head start by supporting an evolving set of rules, providing capabilities to meet the Payer-to-Payer 2023 Proposed Rule from the start allowing you to keep pace with regulations without losing sight of business goals. Our iterative approach leverages the Patient Access API and FHIR from the outset, and leaves the door open to scalability for future directives.  With advance planning and development, everyone benefits now…and into the future.

Efficient. Secure. Accurate. Actionable.

Payers and patients alike want exceptional usability. They also want confidence in the process—and the data itself. The Payer-to-Payer Solution delivers functionality without compromise.

P2P Solution Workflow_Diagram  R10 ORANGE-01

Data exchange authorization and registration authentication.

Members can log in to their new payer’s portal to request a data transfer from their previous payer via the member-facing app’s intuitive user interface, which you can customize for an on-brand, seamless user experience. By employing OAuth2, the industry standard for authorization, patients can grant both the sending and receiving payer access to their health care data without risk to their identities or passwords, safeguarding both consent and privacy.

Plans also can rely on a streamlined data transfer experience through the solution’s OIDC Registration Portal, including the new payer’s OpenID Connect (OIDC) registration and its approval by the previous payer. OIDC protocols add login and profile information about the person signed in to enable secure data exchange between payers.

These features work together to protect confidential data from exposure to unverified third-party applications while ensuring the right information is transferred to the right people.

Data mapping, storage, and analysis.

Smile's FHIR repository is at the core of the solution. The system efficiently transfers data, including older or proprietary data models, from another payer to our repository utilizing the HL7 FHIR standard that is used for storing health records. Actionable insights from data analysis can lead to workflow efficiencies and better patient outcomes.

Take charge of the future.

As interoperability experts and a leader in the FHIR community, we take a proactive approach to health data exchange between payers. We are the first company to receive theScreen Shot 2022-08-15 at 3.15.38 PM (1) Drummond Certification of Compliance, the only independent testing and certification program certifying interoperability and compliance with CMS Final Rule standards.

And whether you are a patient’s new or previous payer, our FHIR experts are with you for the long haul. We offer ongoing support for interoperability challenges as your organization works through current and future regulation processes.

Looking to go-live rapidly with a fully managed solution? Smile offers Managed Services, including 24/7 Premium support, infrastructure and security, so that you can focus on your business, not IT maintenance.

Looking for additional support during implementation? Smile also offers separate Premium Support and Professional Services Packages, for all your technical support needs.