Payer Data Exchange
HealthUnity—ZeOmega’s interoperability solution— is a comprehensive interoperability platform that supports the next generation of health value products. We provide scalable solutions for payer-provider collaboration, lowering administrative burden, and meeting industry compliance requirements.
ZeOmega has deep interoperability experience collaborating with a variety of payers, providers, and vendors through HL7’s DaVinci Project and other FHIR® accelerators. Together, we have pioneered the industry’s interoperability standards and use cases. HealthUnity fully supports the required technical standards, data sets, implementation guides, and use cases for interoperability and exceeds requirements of the CMS Interoperability and Patient Access Final Rule.
HealthUnity empowers health plans to capitalize on their existing infrastructure investments by adapting their data and workflows to align with technologies required to participate in the 21st century healthcare ecosystem using universal, real-time connectivity.
The HealthUnity Difference
By leveraging HealthUnity for interoperability, you get years of expertise in Health Information Exchange, framework development, and use-case creation, especially for:
Turnkey support for CMS recommended reference implementation guides and data sets
Best-in-class secure authentication with OAuth 2.0 and OpenID Connect
Native integration with Jiva for rapid deployment and maximization of your Jiva investment
A single Fast Healthcare Interoperability Resources (FHIR®) gateway to connect with multiple downstream sources via REST APIs or file-based ETL processes
Challenges
Payers
- Struggling to meet CMS and State turnaround time requirements
- 73% PAs submitted using manual process (CAQH 2021)
- Incomplete data for approving request
Providers
- 88% cited Prior Auth as major burden
- Time consuming (spends 2 days/week)
- 93% reported PA caused care delays (AMA 2021 PA Survey)
Patients
- Life threatening delays in care
- Lack of transparency
- Major source of dissatisfaction
Cost
- 90% of manually reviewed requests are ultimately approved
- Duplicative effort between providers and payers
- Unnecessary PAs submitted create noise and overhead
- ML opportunities based on historical PAs by provider
Solution
ZeOmega’s HealthUnity Smart Authorization Gateway is your answer to reducing prior authorization friction. The solution lowers burden by creating an end-to-end, FHIR®-enabled workflow for submitting electronic prior authorization (ePA) requests directly from the providers’ EMRs to payers, which in turn facilitates immediate decisions.
The HealthUnity Smart Authorization Gateway saves time, lowers costs, and reduces delays in patient care.
CMS Interoperability and Patient Access
HealthUnity supports your compliance with the 21st Century Cures Act Final Rule for Interoperability and Patient Access:
Our FHIR interoperability gateway includes native integration with Jiva, enabling streamlined access to information payers must provide to CMS.
Robust plug-and-play connectivity allows real-time access to other relevant data sources such as claim systems and data warehouses.
Out-of-the-box mappings for USCDI-to-Jiva data elements and corresponding FHIR R4 resources, Blue Button profiles, and the CPCDS data set mean are truly turnkey.
HealthUnity connects to a health plan’s system of record (SOR) to provide access to claims and encounter data via both real-time API integration and batch file-based ETL processes.
Our continued investment in FHIR-based interoperability frameworks helps ensure accelerated, cost-effective implementations.
ZeOmega is the first and only population health management (PHM) organization to have successfully passed all three comprehensive data security and interoperability testing programs, known as the “Security and Interoperability Trifecta.” By passing all three testing programs, ZeOmega and its interoperability platform, HealthUnity, are certified as meeting and exceeding the highest industry-defined requirements for data exchange and information security.
The three data security and interoperability certifications ZeOmega has uniquely attained are:
HITRUST’s Common Security Framework (CSF) certified status for information security for Jiva Platform, Jiva Private Cloud, and Information Systems Infrastructure
Drummond Group’s Payer and Patient Access Fast Healthcare Interoperability Resource (FHIR®). Application Programming Interface (API) certification.
EHNAC’s Comprehensive Trusted Dynamic Registration & Authentication Accreditation Program (TDRAAP) accreditation. TDRAAP combines the technical framework using Unified Data Access Profiles (UDAP) in a FHIR® ecosystem with interoperability related Privacy and Security requirements.
HITRUST, Drummond Group, and EHNAC represent the pinnacle of testing programs for healthcare data security and interoperability in the United States, certifying the highest standards of information safely and security. The security of health care data and systems is especially critical today, as the risk of ransomware and other cyber-attacks continues to grow. Safe data exchange is also key to accomplishing critical goals related to regulatory compliance, mitigating risk, and achieving optimal performance in value-based care.
Contact ZeOmega today about leveraging HealthUnity to help your organization meet CMS requirements and enhance your population health management strategy.
