Bridging Access to Clinical and Financial Information – Opportunities and Challenges

By Tammy Banks, MBA

Check Your Understanding.

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* 1. Interoperability and Information Blocking Regulations that apply to health plans and payers are detailed in the Regulations issued by CMS.

True

False

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* 2. The CMS Information Blocking Rule require CMS-regulated plans to provide a patient access API, provider directory API, and payer-to payer API.

True

False

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* 3. The CMS Interoperability and Information Blocking Rule applies to federal and private health plans.

True

False

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* 4. A persistent need is to make the medical, insurance-related and payment information presented to consumers more easily understandable.

True

False

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* 5. Payer to Payer APIs requires Medicare Advantage, Medicaid managed care plans, Children’s Health Insurance Program (CHIP) managed care entities and Qualified Health Plans (QHP) on the federal exchanges to transmit their claims and encounter information, and subset of clinical information to a new health insurer when consumers change plans.

True

False

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