Systems | Development | Analytics | API | Testing

The Provider Access API enables seamless access to patient health data for providers who have both a contractual relationship with the payer and a treatment relationship with the patient. Under the CMS-0057-F Final Rule, impacted payers are required to make the following data available through this API: claims, encounters, and prior authorization information similar to what is shared via the Patient Access API.

The Payer-to-Payer Data Access API enables seamless health information exchange between current and previous/concurrent health plans when a member transitions coverage. Mandated under CMS Rule CMF 0057-F, impacted payers must implement and maintain a FHIR-based API that supports secure transmission of claims, encounter data, USCDI elements, and prior authorization information (excluding provider remittances and patient cost-sharing details).

The Patient Access API, introduced under CMS-9115-F, requires health plans, including Medicare Advantage, Medicaid, the Children’s Health Insurance Program (CHIP), and the Qualified Health Plan (QHP) on federally facilitated exchanges to give patients secure, real-time access to their health data via standardized APIs.

Are you leading the development or marketing of an app or website that involves protected health information (PHI)? If you have not heard the term before, PHI involves information related to an individual’s health status, healthcare, and healthcare payments. The Health Insurance Portability and Accountability Act (HIPAA) protects said individuals and their health-related information, which you must comply with before progressing further with your product or service.

Many pharmaceutical companies have been around for decades and must continually adapt to a rapidly evolving, technology-driven world. Even those that keep pace with digital trends often struggle with data silos and disparate systems, making it difficult to share information across platforms. This fragmentation hinders their ability to meet patient expectations, accelerate drug launches, and develop personalized therapies.

Healthcare software applications have evolved beyond administrative tools, becoming pivotal in patient care, diagnostics, and Electronic Health Record (EHR) management while ensuring regulatory compliance. It ensures that applications like electronic health records (EHRs), telemedicine platforms, or diagnostic systems work accurately, securely, and comply with regulations.

Pfizer, Envision Pharma, Vida Health, Lyra Health, and Maravai LifeSciences use Fivetran to optimize operations, ensure compliance, and drive better patient outcomes.

Automated data integration makes electronic health records more manageable, enhancing operational efficiency and patient outcomes.