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Powering Healthcare Interoperability. Delivering Real-Time Results.
FHIR-Ready. CMS-Compliant. Built for Health Plans. Meet the 2027 FHIR Mandate with Confidence!
Interoperability Is the Mandate — Transformation Is the Opportunity
Health plans are racing toward the January 1, 2027, deadline for CMS-mandated FHIR-based APIs — interoperability isn't just a regulatory checkbox. It's your chance to transform member experience, streamline data exchange, and future-proof your technology stack.
May 1, 2020
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CMS Interoperability and Patient Access Final Rule Published
Established technological foundation for interoperability and patient data access through APIs.
January 1, 2026
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Annual Reporting of Patient Access API Usage
Impacted payers must begin reporting annual metrics about the usage of the Patient Access API to CMS.
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Operational Provisions for Impacted Payers Begin
Impacted payers must start implementing operational provisions for the APIs, laying the groundwork for API development.
January 1, 2027
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Patient Access API Enhancements
Impacted payers must include prior authorization information (excluding drugs) within the Patient Access API, giving patients greater visibility into their care.
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Provider Access API Implementation
Impacted payers must implement the Provider Access API, which allows in-network providers access to patient data, including claims, encounter data, and prior authorization details (excluding drugs). An opt-out process for patients must also be established.
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Payer-to-Payer API Implementation
Impacted payers must implement the Payer-to-Payer API, facilitating the exchange of claims, encounter data, and prior authorization information (excluding drugs) between payers to support care continuity.
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Patient Education and Opt-In Process
Impacted payers must provide educational resources in plain language about the APIs and ensure an opt-in process for the Payer-to-Payer API is in place.
CMS Interoperability Requirements
Interoperability is no longer optional real-time data access is a must!
FHIR Server
A FHIR (Fast Healthcare Interoperability Resources) server is a platform that uses the FHIR standards for exchanging healthcare information electronically. It enables standardized data formats and elements for data sharing.
OAuth 2.0
OAuth 2.0 is an authorization framework that allows applications to obtain limited access to user accounts on an HTTP service. It is used to secure the API endpoints, ensuring that only authorized users and applications can access the data.
Prior Authorization
This API facilitates the electronic submission and management of prior authorization requests and responses. It aims to streamline the process and make it more efficient.
Payer-to-Payer Data Exchange
This requirement ensures that when patients move between health plans, their clinical data is transferred to the new payer to maintain continuity of care.
Provider Directory API
This API enables the sharing of information about healthcare providers within a payer's network, including contact information, specialties, and locations.
Formulary API
This API provides information about a payer's formulary or list of covered drugs, including details on drug coverage, tiering, and any applicable restrictions.
Patient Access API
The API enables patients to access their claims, encounter, & clinical data through a third-party application, including adjudicated claims, encounter data, clinical info.
Interoperability is no longer optional real-time data access is a must!
Medicaid
Government sponsored plans that provides coverage for the needy population.
Medicare
Provides health insurance for individuals 65 and older and some younger individuals with disabilities.
CHIP
Children’s Health Insurance Plan (CHIP) provides health coverage for children outside of the Medicaid marketplace.
AaNeel Connect© Simplifies Data
AaNeel Connect© powers seamless FHIR integration and real-time data access.
The platform fully supports CMS Interoperability and Patient Access requirements, helping health plans achieve compliance and create value beyond the mandate.
Get ahead of the mandate — and your competitors.
Unleash the power of FHIR. AaNeel Connect© is your partner in seamless, future-ready interoperability.
Let’s connect — and bring your data to life.
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