INTEROPERBILITY AND PATIENT ACCESS FINAL RULE (CMS …

Office of Burden Reduction and Health Informatics (OBRHI). Health Informatics and Interoperability Group (HIIG). INTEROPERBILITY AND PATIENT ACCESS FINAL RULE (CMS-9115-F). FREQUENTLY ASKED QUESTIONS (FAQs). ! Table of Contents General CMS-9115-F Overview ..2. PATIENT ACCESS API .3. Payer-to-Payer Data Exchanges ..5. Provider Directory API 6. Compliance and Testing of the Required APIs ..7. Technical .9. Medical Loss Ratio (MLR) for Medicaid MCOs, MA Plans, and Issuers of QHPs on the Federally- Facilitated Exchanges .9. Missing Provider Digital Contact Information and Public Reporting .10. Admission, Discharge, and Transfer PATIENT Event Notification Conditions of Participation (CoP). (42 CFR (d), (f), and (d)) ..11. Proposed Rule on Interoperability and Improving Prior Authorization 18. Public Reporting of Missing Digital Contact Information in NPPES Overview ..18. Digital Contact Information: What is it? What is required?..18. Public Reporting of Missing Digital Contact Information 20.

For the regulatory requirements on impacted payers referenced in this guidance, see 42 CFR part 422 for Medicare Advantage plans; 42 CFR part 431 for state Medicaid fee-for-service programs; 42 CFR part 438 for Medicaid managed care plans, 42 CFR part 457 for CHIP programs, and 45 CFR part 156 for QHP issuers on the FFEs.

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