Thanks to new CMS interoperability mandates and increased adoption of FHIR® standards, it is easier than ever for member data to be shared between healthcare organizations—and that has significant implications for member consent.
CMS-0057-F establishes specific federal requirements around member opt-in/opt-out for payer-to-payer and payer-to-provider data sharing that health plans must follow. In addition, federal data privacy laws prevent health plans from sharing substance use disorder (SUD) information with other entities without prior authorization from members. California health plans and some other states health plans also must comply with additional rules regarding the sharing of behavioral and reproductive health data. Healthcare organizations need robust and flexible information-sharing controls to ensure compliance with current regulations and seamlessly adapt to new ones.
Edifecs Member Consent Management is a workflow solution that enables healthcare organizations to effectively manage member consent. Our solution makes it easy to capture and enforce federal, state, CMS and enterprise data-sharing policies for members and related persons and quickly respond to changes in member data sharing preferences.
