Latest news with #CMS-0057
Business Wire
06-08-2025
- Business
- Business Wire
Availity and Onyx Launch Comprehensive CMS-0057 Compliance Platform for Health Plans Powered by the Availity Network
JACKSONVILLE, Fla. & MISSION HILLS, Kan.--(BUSINESS WIRE)-- Availity®, the nation's largest real-time health information network, and Onyx, a leader in FHIR®-based interoperability, have partnered to deliver a comprehensive, out-of-the-box solution to help health plans meet the requirements of the CMS-0057 Interoperability and Prior Authorization Final Rule. The joint platform is designed to simplify compliance, reduce administrative burden, and future-proof payer infrastructure for evolving regulatory and operational needs. 'Our partnership with Availity brings together best-in-breed capabilities across our respective platforms." said Mark Scrimshire, Chief Product Officer at Onyx. The CMS-0057 rule, finalized by the Centers for Medicare & Medicaid Services (CMS), mandates that impacted payers implement a suite of APIs and reporting capabilities by January 1, 2027. CMS estimates a 30-month timeline for implementation and testing to meet full compliance 1. With less than 18 months away from compliance deadlines, health plans are facing challenging implementation timelines. Backed by a team with deep interoperability expertise that helped define the industry standard and a national payer-provider-vendor network, The Availity-Onyx solution delivers a proven, scalable path to help health plans not only meet compliance but effectively drive value and ROI via scaled FHIR interoperability. Solution capabilities include: FHIR server management: Flexible, secure and cloud-agnostic FHIR operating system with a robust data transformation layer to standardize data into FHIR resources and built-in support for CMS interoperability mandate compliance Patient Access and Provider Directory APIs: Enables members access to claims, encounters, and clinical data via mandated FHIR APIs, conforming to the CARIN IG for Blue Button® and also including a developer portal and app store for third-party integrations Prior Authorization APIs: Enables end-to-end authorization connectivity across Availity's vast network of delegated UM/HIT vendors, providers and health plans to fully transform the electronic prior authorization experience Payer-to-Payer API and Connectivity Hub: Supports sharing of clinical, claims and prior authorization data and facilitates secure, real-time data exchange between health plans and across the Availity Payer-to-Payer Connectivity Hub Provider Access API and Connectivity Hub: Enables mandate compliance allowing providers to retrieve patient-specific data securely and efficiently, directly from the health plan and via Availity's Provider Connectivity Hub Meeting the Mandate: Why Interoperability Matters The CMS-0057 regulation is a transformative step toward a more connected healthcare ecosystem. By requiring payers to adopt standardized APIs for patient access, provider access, payer-to-payer data exchange, and prior authorization, CMS aims to reduce administrative burden, improve patient outcomes, and enhance transparency across the care continuum. 'CMS-0057 is a pivotal moment for the healthcare industry,' said Mark Scrimshire, Chief Product Officer at Onyx. 'Our partnership with Availity brings together best-in-breed capabilities across our respective platforms to enable health plans to meet these mandates with confidence—while also unlocking long-term value through automation, interoperability, and improved provider collaboration. We're incredibly excited to collaborate with Availity to introduce this solution to the nation's leading healthcare network.' Moving beyond the Mandate: A Unified Platform for Seamless Compliance The Availity-Onyx solution is designed to deliver more than just compliance—it's built for confidence and long-term value. Key platform features include: Accelerated Compliance: Out-of-the-box support for all CMS interoperability mandates, ensuring fast, seamless compliance National Network: Eliminates costly point-to-point integrations and accelerates adoption across stakeholders Proven Scalability: Cloud-agnostic and FHIR-native—minimizing internal IT burden while offering flexibility to scale with evolving regulatory and business needs Seamless Integration: API-first architecture, SMART-on-FHIR authentication, and robust data transformation capabilities enable smooth integration Trusted Expertise: Deep experience in FHIR, HL7, and DaVinci workgroups, with leadership in major federal interoperability initiatives Robust Reporting: Real-time dashboards and CMS-compliant metrics provide actionable insights, transparency, operational oversight and continuous improvement opportunities 'We've built this solution to go beyond compliance,' said Sean Barrett, Chief Product Officer at Availity. 'By embedding FHIR-native APIs and real-time data exchange into payer workflows, we're laying the foundation for a more connected, efficient, and patient-centered healthcare system.' About Availity Availity empowers payers and providers to deliver transformative patient experiences by enabling the seamless exchange of clinical, administrative, and financial information. As the nation's largest real-time health information network, Availity develops intelligent, automated, and interoperable solutions that foster collaboration and shared value across the healthcare ecosystem. With connections to over 95% of payers, more than 3 million providers, and over 2,000 trading partners, Availity provides mission-critical connectivity to drive the future of healthcare innovation. For more information, including an online demonstration, please visit or call (282.4548). Follow us on LinkedIn and X. About Onyx Onyx is the leader in health data interoperability, delivering standards-based, flexible, and cost-effective solutions that make data easier to access, use, and trust. Our Best in KLAS technology supports real-world workflows with secure, scalable architecture, while our deep industry expertise and strong partner network help payers and providers connect faster, reduce costs, and stay ahead of evolving regulations Learn more at
Miami Herald
29-05-2025
- Business
- Miami Herald
1upHealth Launches Prior Authorization Solution and Technology Partnerships to Support CMS Electronic Prior Authorization Mandate for Health Plans
New Product Streamlines Prior Authorization to Improve Patient, Provider, and Payer Outcomes BOSTON, MA / ACCESS Newswire / May 29, 2025 / 1upHealth, a leader in health data interoperability, today announced the launch of its 1up Prior Authorization solution. The solution is designed to ensure compliance with the CMS Interoperability and Prior Authorization final rule (CMS-0057) while delivering measurable ROI through reduced provider burden and lower administrative costs for payers. To accelerate adoption of electronic Prior Authorization (ePA), 1upHealth is also building strategic partnerships with Utilization Management (UM) and Prior Authorization (PA) policy vendors. These partnerships aim to simplify integration and speed up deployment for payer customers. While PA programs are intended to manage costs, current processes are largely manual and create significant burdens across the healthcare system. For providers, this burden translates to less time spent on patient care; for payers, it drives up administrative costs and hinders member experience. According to the American Medical Association, 29% of physicians reported that PA led to serious adverse events for patients, and nearly 90% said it contributes to physician burnout. Separately, CAQH estimates that transitioning to ePA could save the industry at least $515M annually. The 1up Prior Authorization solution digitizes and streamlines the PA process for health plans by managing complex integrations and providing real-time visibility, flexibility, and control at every stage. Built in accordance with Da Vinci FHIR Implementation Guides, the tool enables connectivity with all major EHRs, PA policy vendors, and utilization management systems. By simplifying prior authorization workflows, 1upHealth's solution not only ensures regulatory compliance but also delivers measurable improvements for patients, providers, and payers. "The CMS final rule not only set the stage for healthcare's long overdue digital transformation, but it provided the kindling needed to solve one of the industry's biggest pain points: prior authorization," said Andrew Boyd, CEO of 1upHealth. "With 1upHealth's latest releases, we're taking away the complexity of the PA process while going beyond compliance to drive critical outcomes such as: reduced administrative costs and improved efficiency for payers; broader adoption and reduced burden for providers; and, most importantly, improved outcomes and higher satisfaction for patients." 1upHealth is also building its ecosystem of PA partners, offering a comprehensive end-to-end ePA solution that integrates into a health plan's existing technology stack. The 1up Prior Authorization solution connects to all industry EHRs, PA policy vendors, and UM vendors. Today, 1upHealth is integrated with EHR vendors Epic and Meditech; UM transformation provider Cohere Health; and prior authorization systems vendor Itiliti Health. Additional technology partners are actively testing and growing the ecosystem. "Healthcare's longstanding interoperability issues have made it frustratingly difficult to solve even the most basic challenges, such as ensuring patients receive the right care at the right time," said Mohammad Jouni, Chief Product and Technology Officer of 1upHealth. "1upHealth is changing that by making it dramatically easier to access and integrate health data. This unlocks critical use cases like electronic prior authorization that not only improve clinical outcomes, but also streamline operations and eliminate the inefficiencies the industry has long accepted as inevitable. This is the foundational infrastructure healthcare has always needed but too often overlooked, and I'm proud that 1upHealth is leading the charge." 1upHealth will host a webinar on June 4, titled "ePA in Action: Live Demo + Roadmap to CMS-0057 Compliance" to cover the ePA requirements and introduce its new solution. To learn more and register, visit this page. About 1upHealth Driven by a purpose of better healthcare for all through better data, 1upHealth is the national leader in health data interoperability and one of the fastest-growing health IT companies in the United States. Our modern data platform is built on a standards-based cloud architecture specifically designed for the healthcare industry, making it easy to acquire, manage, share, and compute data. From leading health plans and state Medicaid agencies to innovative digital health organizations and top-performing ACOs, over 90 health organizations rely on 1upHealth to seamlessly exchange data across the healthcare ecosystem to reduce risk, lower costs, and improve patient outcomes. Media Contact Elizabeth Grich Aria Marketing for 1upHealth egrich@ SOURCE: 1upHealth
Associated Press
29-05-2025
- Business
- Associated Press
1upHealth Launches Prior Authorization Solution and Technology Partnerships to Support CMS Electronic Prior Authorization Mandate for Health Plans
New Product Streamlines Prior Authorization to Improve Patient, Provider, and Payer Outcomes BOSTON, MA / ACCESS Newswire / May 29, 2025 / 1upHealth, a leader in health data interoperability, today announced the launch of its 1up Prior Authorization solution. The solution is designed to ensure compliance with the CMS Interoperability and Prior Authorization final rule (CMS-0057) while delivering measurable ROI through reduced provider burden and lower administrative costs for payers. To accelerate adoption of electronic Prior Authorization (ePA), 1upHealth is also building strategic partnerships with Utilization Management (UM) and Prior Authorization (PA) policy vendors. These partnerships aim to simplify integration and speed up deployment for payer customers. While PA programs are intended to manage costs, current processes are largely manual and create significant burdens across the healthcare system. For providers, this burden translates to less time spent on patient care; for payers, it drives up administrative costs and hinders member experience. According to the American Medical Association, 29% of physicians reported that PA led to serious adverse events for patients, and nearly 90% said it contributes to physician burnout. Separately, CAQH estimates that transitioning to ePA could save the industry at least $515M annually. The 1up Prior Authorization solution digitizes and streamlines the PA process for health plans by managing complex integrations and providing real-time visibility, flexibility, and control at every stage. Built in accordance with Da Vinci FHIR Implementation Guides, the tool enables connectivity with all major EHRs, PA policy vendors, and utilization management systems. By simplifying prior authorization workflows, 1upHealth's solution not only ensures regulatory compliance but also delivers measurable improvements for patients, providers, and payers. 'The CMS final rule not only set the stage for healthcare's long overdue digital transformation, but it provided the kindling needed to solve one of the industry's biggest pain points: prior authorization,' said Andrew Boyd, CEO of 1upHealth. 'With 1upHealth's latest releases, we're taking away the complexity of the PA process while going beyond compliance to drive critical outcomes such as: reduced administrative costs and improved efficiency for payers; broader adoption and reduced burden for providers; and, most importantly, improved outcomes and higher satisfaction for patients.' 1upHealth is also building its ecosystem of PA partners, offering a comprehensive end-to-end ePA solution that integrates into a health plan's existing technology stack. The 1up Prior Authorization solution connects to all industry EHRs, PA policy vendors, and UM vendors. Today, 1upHealth is integrated with EHR vendors Epic and Meditech; UM transformation provider Cohere Health; and prior authorization systems vendor Itiliti Health. Additional technology partners are actively testing and growing the ecosystem. 'Healthcare's longstanding interoperability issues have made it frustratingly difficult to solve even the most basic challenges, such as ensuring patients receive the right care at the right time,' said Mohammad Jouni, Chief Product and Technology Officer of 1upHealth. '1upHealth is changing that by making it dramatically easier to access and integrate health data. This unlocks critical use cases like electronic prior authorization that not only improve clinical outcomes, but also streamline operations and eliminate the inefficiencies the industry has long accepted as inevitable. This is the foundational infrastructure healthcare has always needed but too often overlooked, and I'm proud that 1upHealth is leading the charge.' 1upHealth will host a webinar on June 4, titled 'ePA in Action: Live Demo + Roadmap to CMS-0057 Compliance' to cover the ePA requirements and introduce its new solution. To learn more and register, visit this page. About 1upHealth Driven by a purpose of better healthcare for all through better data, 1upHealth is the national leader in health data interoperability and one of the fastest-growing health IT companies in the United States. Our modern data platform is built on a standards-based cloud architecture specifically designed for the healthcare industry, making it easy to acquire, manage, share, and compute data. From leading health plans and state Medicaid agencies to innovative digital health organizations and top-performing ACOs, over 90 health organizations rely on 1upHealth to seamlessly exchange data across the healthcare ecosystem to reduce risk, lower costs, and improve patient outcomes. Media Contact Elizabeth Grich Aria Marketing for 1upHealth [email protected] SOURCE: 1upHealth press release
