Cheat Sheet

The Interoperability Mandate

    Key Takeaways
    • Payers offering government-purchased or subsidized plans must build and implement specific APIs, or standardized data transfer infrastructures, for patient information and provider directories by July 1, 2021. They will also have to enable payer-to-payer data exchange by January 1, 2022.
    • Patients can request personal clinical and claims data through third-party apps, creating opportunities for better engagement and introducing a new player to the payer-member relationship.
    • Payers will have access to historical medical information for new members, helping them identify and address care quality gaps and improve their risk adjustment coding.

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