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FHIR® Gateway
Seamless, compliant, and interoperable data exchange
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Healthcare organizations need to deliver a more seamless and interconnected healthcare experience. Not just because that’s what patients and members expect, but because the CMS Interoperability & Patient Access and Interoperability & Prior Authorization final rules (CMS-9115-F and CMS-0057-F) require it. To meet consumers’ expectations and maintain ongoing compliance with regulatory guidelines, healthcare organizations need to invest in a reliable infrastructure that supports strategic interoperability.
Edifecs’ FHIR® Gateway is designed to streamline and standardize the data exchange between health plans, providers, and patients. The SaaS solution is part of our comprehensive Healthcare Interoperability Cloud and has been rated Best in KLAS for CMS Payer Interoperability in 2023 and 2024.
Modernize and streamline data exchange
Ensure ongoing compliance and deliver a better member experience with our award-winning interoperability platform.
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FHIR Gateway Products
CMS-0057-F
Payer to Payer Data Exchange
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Frequently Asked QuestionsUse Tab to navigate between questions, Enter or Space to expand/collapse answers
01 Why is interoperability so important for healthcare organizations?
The average patient sees 19 doctors in their lifetime. For patients with complex conditions or multiple comorbidities requiring specialist care, that number can be significantly higher. It is essential that their medical information flows seamlessly between providers and their health plan.
Achieving interoperability ensures that patients, providers, and health plans can easily access the right information at the right time to support better patient care and outcomes, reduce errors, and improve operational efficiency.
02 How does FHIR support healthcare interoperability?
Healthcare organizations utilize a variety of different systems; unfortunately, many of these systems weren’t designed to work well with others. To bridge the gaps between systems, organizations have traditionally relied on custom interfaces and point-to-point integrations, which are both expensive and time-consuming to maintain.
FHIR establishes a set of standards for data exchange across disparate systems. Utilizing FHIR APIs, enables healthcare organizations to more easily connect and share data without the need for redesigns or customizations.
03 What are FHIR APIs? How do they work?
An API (Application Programming Interface) allows applications to communicate and extract and share data with one another. For an API to work, the data being exchanged needs to be comprehensible to both applications; however, healthcare data has become increasingly complex, and even minor variations in how one application formats data elements can make it unreadable to another application.
FHIR APIs standardize those data elements to ensure that information can be exchanged between different systems regardless of how it is stored or formatted in each system.
04 How does FHIR support compliance with CMS guidelines?
The CMS Interoperability and Patient Access Final Rule (CMS-9115-F) requires payers to implement APIs to improve the electronic exchange of healthcare data. CMS later expanded upon these requirements in the Interoperability and Prior Authorization Final Rule (CMS-0057-F), which provided more guidance regarding APIs for patient access, provider access, payer-to-payer data exchange, and prior authorization.
With a compliance deadline of no later than January 1, 2027, health plans must improve their interoperability through the use of APIs. FHIR APIs offer payers the fastest and least resource-intensive path to compliance.