BOSTON: Abacus Insights, the leader in data usability for U.S. payers, is expanding its industry-leading CMS Interoperability data solution to enable health plans to comply with the Centers for Medicare and Medicaid Services’ latest and most ambitious mandate, CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). Built on Abacus Insights’ usable data platform for payers, the solution is fully integrated with the CMS interoperability platform of Onyx, bringing to market a new suite of turnkey compliance modules that enables payers to meet CMS-0057-F requirements seamlessly and cost-effectively, starting with the looming early 2026 metrics reporting deadline.

Abacus Insights’ CMS Interoperability data solution meets payers where they are in their CMS compliance journey, enabling them to achieve compliance with the current CMS-9115-F mandate and accelerated implementation of CMS-0057-F requirements. With this data solution, payers can build and enrich a foundation of clinical data assets while meeting mandates to provide patient access, provider access, payer-to-payer, and prior authorization APIs and improving prior authorization processes.

The solution ensures payers receive the new standard of usable data—complete, accurate, timely, relevant, versatile and for use cases and applications specific to interoperability. Delivering optimal flexibility to payers, the solution modules can be deployed individually, in combination or fully integrated in a payer’s preferred environment.

• Patient Access API. Real-time digital access of clinical, formulary, explanation of benefits, and prior authorization data for members to facilitate transparency and drive informed decision-making.
• Provider Access API. Bulk exchange of claims and clinical data with in-network providers via EHRs to facilitate care coordination and burden reduction for providers.
• Payer-to-Payer API. Ability to electronically exchange claims and clinical data between payers when members switch health plans.
• Electronic Prior Authorization (ePA) Support. Support providers’ submission of prior authorization requests from their EHR/EMR while enabling your utilization management ecosystem to consume electronic prior authorization requests and make determinations within defined turnaround times.

“Interoperable usable data is fundamental to improving patient care, access, experience and outcomes. But getting there is a monumental undertaking with the new requirements representing a significant technical and operational challenge for payers with a short runway,” said Minal Patel, MD, Abacus Insights CEO and Founder. “We’ve designed our data solution to support payers at any stage of interoperability readiness, ensuring compliance with current and imminent mandates and the flexibility to adapt and scale as payer needs for interoperable healthcare data evolve.”

Payers are able to extract greater value from the Abacus Insights’ CMS Interoperability data solution because it ensures data usability. Abacus Insights makes data usable by consolidating, standardizing, and validating data from internal and external sources, transforming and enriching it to drive analytical and operational use cases.

With the only HITRUST r2-certified and SOC 2-certified data transformation platform and solutions developed specifically for payers, Abacus Insights begins delivering value within 4 to 6 months with a 60% lower TCO than internal builds. Managing data for more than 23 million health plan members, Abacus integrates with and leverages legacy tech stacks while maintaining tech currency.

About Abacus Insights

Abacus Insights is a healthcare technology leader with the only data usability platform and data solutions built specifically for payers. By setting the new standard of payer data to usability, Abacus Insights gives payers a new level of control and flexibility to support analytics and operational use cases. Managing data for 23+ million members, Abacus Insights partners with payers to deliver scalable solutions that drive strategic initiatives, control costs, and improve member lives and experiences.

Fonte: Business Wire