Payer Workgroup Publishes Payer-to-Payer FHIR API Compliance Readiness Checklist Ahead of CMS Deadline

The Sequoia Project, a leading non-profit focused on advancing healthcare interoperability, is pleased to publish the “Payer-to-Payer Compliance Readiness Checklist.” This checklist is designed to help payers assess their readiness for compliance with the payer-to-payer components of CMS-0057-F, a critical regulation for improving data sharing and interoperability in healthcare. 

Implementation Resource for Payer Organizations

Developed by Interoperability Matters’ Payer-to-Payer FHIR API Implementation Workgroup, the readiness checklist serves as a resource for any payer seeking to implement the Centers for Medicare & Medicaid Services (CMS) regulation. This editable checklist provides an easy-to-use framework that helps identify both explicit and implicit regulatory and operational requirements, ensuring payers are well-prepared to meet compliance standards.

“The Payer-to-Payer FHIR API Implementation Workgroup is a collective national effort,” said Mariann Yeager, chief executive officer of The Sequoia Project. “It is important payer interoperability is prepared for the upcoming CMS deadline.”

Typically, patients may opt to change their health insurance companies, i.e., payers, on an annual basis. The CMS regulations are meant to ensure that the exchange of information between the previous and new payers accompanies the switch. For payers, the mandated interoperability changes provide opportunities to improve member satisfaction, streamline operations, and enhance care continuity.

“There are less than 20 months left until the regulation goes into effect on Jan. 1, 2027,” said Nancy Beavin, director provider connectivity at Medica and co-chair of the Payer-to-Payer Workgroup. “The checklist is an invaluable resource for payers navigating the complexities of CMS-0057-F on a deadline.” 

Supporting Payers in Achieving Compliance

The new checklist complements existing efforts and initiatives in the field by guiding payers step-by-step through the essential operational and regulatory considerations of CMS-0057-F. Although the initial release of the checklist focuses primarily on business and operational readiness, it provides the necessary foundation for future technical implementations.

“The goal of this regulation is to improve continuity of care for patients when they change their health plans,” said Robert Oakley, strategy and interoperability lead at Evernorth Health Services, and co-chair of the Payer-to-Payer Workgroup. “This checklist makes it easier for payers to facilitate the payer-to-payer exchange.” 

Get Involved and Stay Informed

Interested in working with others to achieve payer-to-payer compliance with CMS-0057-F? If you are interested in participating in the Payer-to-Payer Workgroup, contact interopmatters@sequoiaproject.org to join the next meeting on April 15 from 2-3:30 p.m. Eastern. The first three workgroup meetings are complimentary for non-members of The Sequoia Project.