AWS HealthLake now supports CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requirements

AWS HealthLake now provides native support for healthcare payers to comply with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). This rule requires Medicare Advantage organizations, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers to implement four standardized FHIR-based APIs by January 1, 2027.

New capabilities

Patient Access API

• CARIN IG for Blue Button® 2.1.0 — enables patients to access their claims, encounter data, and prior authorization information through third-party applications 

• SMART App Launch 2.0.0 — provides secure, standards-based authorization for patient-facing applications

• DaVinci PDex Drug Formulary 2.1.0 — allows patients to query drug coverage information

• API use metrics collection — supports the annual reporting requirement for aggregated, de-identified Patient Access API usage data

Provider Access API 

• CARIN IG for Blue Button® 2.1.0 — enables sharing of patient claims and encounter data with in-network providers

• DaVinci PDex 2.1.0 — supports payer-to-provider clinical data exchange

• DaVinci PDex Drug Formulary 2.1.0 — provides drug formulary information to treating providers

• Consent management integration — supports patient opt-out workflows and provider attribution through integration with AWS services 

Payer-to-Payer API

• CARIN IG for Blue Button® 2.1.0 — facilitates claims and encounter data exchange between payers

• DaVinci PDex 2.1.0 — supports clinical data exchange across payer boundaries

• $bulk-member-match operation — enables payers to identify shared members at scale for data exchange, supporting the requirement to request patient data from previous payers within one week of coverage start 

• $bulk-member-match status tracking — provides asynchronous status polling for large-scale member matching operations

• DaVinci Data Export — supports bulk FHIR data export aligned with the DaVinci implementation guide for efficient payer-to-payer data transfer

• Group Discovery APIs — enables auto-discovery of resource types available for export, streamlining payer-to-payer integration

• Consent management integration — supports patient opt-in workflows required for payer-to-payer data exchange 

Prior Authorization API

• DaVinci Coverage Requirements Discovery (CRD) 2.1.0 — allows providers to query whether prior authorization is required and discover documentation requirements for items and services

• DaVinci Documentation Templates and Rules (DTR) 2.1.0 — supports compilation of necessary documentation to accompany prior authorization requests

• DaVinci Prior Authorization Support (PAS) 2.1.0 — enables end-to-end electronic prior authorization including submission, status tracking, and decision communication via FHIR APIs 

• SMART App Launch 2.0.0 — provides secure authorization for prior authorization workflow applications

• Prior authorization metrics support — enables payers to collect and expose required metrics including approval rates, denial rates, appeal outcomes, and average decision timeframes

 

AWS HealthLake is a HIPAA-eligible service. Customers are responsible for determining their own compliance obligations under CMS-0057-F and should consult with legal and compliance counsel regarding their specific requirements.

AWS HealthLake is available in the US East (N. Virginia), US East (Ohio), US West (Oregon), Asia Pacific (Mumbai), Europe West (London), Europe (Ireland), and Asia Pacific SouthEast (Sydney) Regions. Visit the AWS Region Table to see all the regions.

 

To learn more, see the AWS HealthLake product page and AWS HealthLake Developer Guide.

Categories: general:products/amazon-healthlake

Source: Amazon Web Services

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