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Practical Considerations on CMS 9115
Payer-to-Payer Data Exchange

  • July 27, 2021
  • 1:00 PM – 2:00 PM ET
  • Online
about

Health insurance providers have just started to go live on the first phase of the CMS Interoperability Rule, implementing the Patient Access and Provider Directory APIs. Forward thinking health insurance providers have started to think about the next phase of the rule – the Payer-to-Payer exchange – which needs to be implemented by January 1, 2022. The Payer-to-Payer requirements have less technical specificity, and without the help of specific Implementation Guides, health insurance providers are trying to determine how to best meet the rules. To overcome some of these challenges, the HL7 Da Vinci Project has proposed some potential solutions to streamline data sharing between health insurers.

This webinar will highlight some of the technical and workflow challenges associated with the current regulation, highlighting how ingesting data in different formats may lead to additional overhead for health insurance providers. The presenters will discuss options for implementing the CMS Payer-to-Payer exchange, including how the HL7 Da Vinci Project Implementation Guides can help streamline implementations. Discussion will include the workflow and technical requirements of the Da Vinci Implementation Guides.

Attendees will learn about:

  • The current regulatory requirements for implementing Payer-to-Payer exchange
  • Potential challenges the existing rules will create for health insurance providers and their members
  • Proposed requirements under the CMS Interoperability and Prior Authorization rule (9123-P) that is under review by the new Administration and is aimed at helping inform health insurance providers and vendors about potential Implementation Guides
  • The Da Vinci PDeX/HREX Implementation Guides as a potential solution for health insurance providers

Speakers


Lynda Rowe
Senior Advisor, Value-Based Markets
InterSystems

Ms. Lynda Rowe is Senior Advisor for Value-Based Markets at InterSystems acting as a subject matter expert around the shift to value-based payment models and payers adoption and use of data as a strategic asset. She shares her expertise with customers and the industry through her speaking engagements and published pieces. For the past two decades, Ms. Rowe has held senior-level positions in health information technology. Her experience spans work for payers, health systems, start-ups, vendors and the federal government.

Prior to her role at InterSystems she was an executive in the health market at Booz Allen Hamilton, where she led a number of consulting projects for the Centers for Medicare and Medicaid and the Office of the National Coordinator within HHS. She provided leadership for quality measurement, health information technology use and adoption, health information exchange, interoperability and standards. She continues to be active in a number of national efforts including the HL7 Da Vinci project.


Melanie Davies
Product Manager
InterSystems

Melanie Davies is a Product Manager for the Unified Care Record, a foundational component of the HealthShare suite of products at InterSystems. Her focus is on the data—  the model, pipelines, and standards. She has a Master’s degree in Health Informatics from Northeastern University and previous product management roles at healthcare and health research institutions.


Vanessa Candelora
Senior Consultant
Point of Care Partners

Vanessa Candelora is a senior health information technology consultant with Point-of-Care Partners with over 15 years’ experience implementing and managing complex health care and technology related initiatives, programs and/or products. She is currently the Project Manager for Da Vinci, a Payer/Provider led initiative to leverage HL7 FHIR © to exchange critical data required for Value Based Care contracts.

Prior to POCP, Vanessa worked for MedeAnalytics with healthcare data analytics products supporting Health Payers, IDNs, and Providers including Employer Reporting, Provider Analytics and Value-Based Performance Management (VBPM) solutions where she led the Payer Account Management team through transition from a custom development organization to a SaaS product company. Vanessa also worked at NaviNet, now NantHealth, project managing technical improvement projects including Master Data Management, provider registration and supported teams implementing standard data exchange projects for Payer/Provider interoperability across several workflows.