PAYERS

Payers today are facing pressure to ingest and process data faster, changes in the regulatory landscape, and competitive pressures. Innovative payers are investing in interoperability strategies built on the FHIR^® open standards that not only solve the data ingestion issue but also mandate compliance, risk adjustment, and care management and coordination. Truly interoperable data and IT solutions that are secure, scalable and can be modularly deployed when needed, optimize payer systems, while increasing care quality. 

FHIR is healthcare’s leading open standard for data exchange and interoperability. Smile’s Health Data Platform is the commercial FHIR-native Health Data Platform for standardized, structured, and computable data. It ingests data from disparate legacy sources across provider EHRs, claims, member systems and third-party systems while enhancing quality and governance. Smile also provides data access security through consent and identification rules which facilitate compliance. 

Standardize data ingestion into structured FHIR resources to build a unified and secure healthcare data source that you can rely on to make better business and clinical decisions 

The CMS-0057-F Interoperability and Prior Authorization Rule has a complicated set of requirements that will be enforced on January 1, 2027. Your organization’s journey to compliance is unique. Whether you need an out-of-the-box product, or some basic API integrations to fit within your existing tech stack, Smile’s CMS Suite offers a flexible solution and to help you achieve compliance today, and build foundations for tomorrow. Our solution suite delivers for innovative payers who want to do more with their data and go beyond the minimum mandate requirements to achieve the benefits of value-based care.

Achieve and exceed compliance with a flexible and comprehensive CMS Suite that streamlines and simplifies processes across the payer network.