Interoperability Matters

Payer-to-Payer FHIR® API Implementation Workgroup

Established by the Interoperability Matters Leadership Council, the Payer-to-Payer FHIR® API Implementation Workgroup will explore existing obstacles inhibiting the payer community’s business and propose recommendations to improve interoperability amongst payers.

2022 MEETING SCHEDULE: QUARTERLY (FEBRUARY 11, MAY 13, SEPTEMBER 9) 12:00-1:30PM ET

Workgroup Purpose

Leveraging the existing HL7® Da Vinci and CARIN technical and policy requirements (e.g., FHIR® Implementation Guides) that have direct impact on the payer community, this Workgroup will identify practical, implementation-level implications from a business and governance perspective. It will be cognizant of broader stakeholder needs and may eventually broaden its focus to other payer exchange partners but, initially, it will remain focused on operational aspects of payer-to-payer FHIR® API exchange and related activities.

Workgroup's Primary Goal for 2024

To convene payer stakeholders to collectively work towards solving the shared challenge of implementing Payer-to-Payer FHIR® APIs and cultivating a Community of Practice (CoP) to enable efficiencies through shared learnings, resources, and best practices. 

  • The initial charge will be to create actionable business governance and operational best practices to achieve interoperable data exchange among and between payers using HL7®FHIR®
  • The CoP will facilitate dialogue to identify gaps in resources, develop recommendations to improve payer implementation readiness, and inform relevant policy frameworks in a practical and consistent manner.
  • The CoP will also work with payers to assist in planning for the potential gains from having access to historical data retrieved from past payers on member start.

Cultivating a Community of Practice

The Workgroup will begin with a landscape review to understand existing technical and policy requirements. The intent is to leverage and learn from payer stakeholders and enable efficiencies through shared learnings, resources and best practices.

Workgroup Co-Chairs

Nancy Beavin

Medica

Robert Oakley

Evernorth

Join the Workgroup

This workgroup provides a vital community of practice for those responsible for ensuring their organization’s readiness and compliance with federal regulations. There’s no need to do it alone when you can learn from industry experts, benefit from shared best practices, and work collectively to inform policy.

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