Payers
Streamline prior authorizations and exchange clinical documentation with ease.
Healthcare faces inefficient and disjointed workflows related to prior authorization, medical reviews, billing, and payment. This makes it extremely difficult for payers and providers to administer these processes, delaying care for those patients who need it.
eHealth Exchange is an HL7® Da Vinci member working to solve this for all payers, providers and patients.
Connecting payers and providers
We provide a single nationwide legal agreement with one technical connection for you to connect to providers, federal agencies, health information exchanges, and other payers enabling a simplified information exchange process and a proven SMART-on-FHIR approach to payer APIs.
With eHealth Exchange, you can:
Streamline and automate prior authorization decisions and provide real-time determinations.
Expediate medical reviews with on-demand access to clinical documentation to support the claims process.
Reduce administrative burden by minimizing the back-and-forth information requests.
Support care coordination and value-based care determinations.
Increase compliance with federal regulations for payer interoperability.
Discover the many benefits of exchanging via eHealth Exchange.
Fully implemented FHIR API solution
The Centers for Medicare & Medicaid Services (CMS) has selected Health Level 7® (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) as the payer API in CMS-0057 final rule. They’re giving you until 2027 to implement it, but why wait?
eHealth Exchange has already fully adopted and deployed FHIR successfully nationwide. This same approach is being used to connect payers and providers to exchange for prior authorization and supplemental clinical document exchange.
Join now to get ahead on your FHIR implementation and help shape Networked FHIR interoperability for payers and providers.
Clinical data exchange at scale
Payers and providers actively exchange patient-specific clinical data today to address care gaps for HEDIS, and other quality efforts and risk adjustment. Payers retrieve population-level clinical data for attributed patients to reduce manual chart-chasing.
Networked FHIR is the scalable solution necessary to provide consistency and automation to reduce payer and provider burden. It offers a single connection to multiple network participants and enables a single user workflow.
Leverage our common trust agreement and Networked FHIR along with HL7 Da Vinci specifications, and you eliminate costly one-to-one connections and standardize clinical data exchange.
Incentivizing payer interoperability
We recognize the investments needed to innovate, and we stepped up to help payers engage.
In late 2023, we offered financial incentive to the first three payers to successfully exchange patient data with providers or HIEs via eHealth Exchange FHIR capabilities.
Why payers choose eHealth Exchange
Trusted exchange | Proven security | Certified data quality | Commitment to privacy
We are reducing administrative burden by making it easy to get the information you need to address care demands for up to 250 million patients.
One Legal Agreement
One Connection
Connect via a single set of APIs, meaning you can share health data with other participants – without additional customizations or point-to-point integrations.
Network Governance
Transparency
High Quality Data
