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Payer Solutions

Payer Solutions

Custom solutions for payer workflows and health plan operations.
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Showing 1–9 of 9 results

Clinical Data Exchange  (Da Vinci CDEX)
Clinical Data Exchange (Da Vinci CDEX)

Part of a set of Prior Authorization APIs allowing providers to transmit solicited or unsolicited documents to payers using FHIR.

PayerInteroperabilityBusinessSolutioninteroperabilityn/aPayer
Prior Authorization Support (Da Vinci PAS)
Prior Authorization Support (Da Vinci PAS)

Part of a set of Da Vinci's Prior Authorization API's allowing providers to submit fhir based prior authorizations to payers, referenced by CMS mandate 0057-f

PayerInteroperabilityBusinessSolutioninteroperabilityn/aPayer
Documents Templates & Rules (Da Vinci DTR)
Documents Templates & Rules (Da Vinci DTR)

Part of a set of Da Vinci's Prior Authorization API's allowing providers and Payers to interact using questionnaires, referenced by CMS mandate 0057-f

PayerInteroperabilityBusinessSolutioninteroperabilityn/aPayer
Coverage Requirements Discovery (Da Vinci CRD)
Coverage Requirements Discovery (Da Vinci CRD)

Part of a set of Da Vinci's Prior Authorization APIs allowing providers and interact using CDS Hooks at the point of care, referenced by CMS mandate 0057-f

PayerInteroperabilityBusinessSolutioninteroperabilityn/aPayer
Provider Access Bulk API (Da Vinci PDEX)
Provider Access Bulk API (Da Vinci PDEX)

The Provider Access is a bulk API referenced as part of the CMS mandate 0057-F, the Interoperability and Prior Authorization Final Rule

PayerInteroperabilityBusinessSolutioninteroperabilityn/aPayer
Payer to Payer Bulk API (Da Vinci PDEX)
Payer to Payer Bulk API (Da Vinci PDEX)

The Payer to Payer bulk API is based on the CMS 9115-F (single-member API) and is part of CMS 0057-F (bulk Payer Data Exchange.

PayerInteroperabilityBusinessSolutioninteroperabilityn/aPayer
Provider Directory - (Da Vinci Plan-Net API)
Provider Directory - (Da Vinci Plan-Net API)

The Provider Directory is mandated by CMS 9115-F (Patient Access Rule) for payers. The solution is based on Da Vincis Plan-Net Implementation Guide

PayerInteroperabilityBusinessSolutioninteroperabilityn/aPayer
Patient Access Formulary API (Da Vinci PDEX)
Patient Access Formulary API (Da Vinci PDEX)

The formulary api is a requirement part of the CMS Mandate 9115-F (Patient Access Rule – Drug Formulary API requirement)

PayerInteroperabilityBusinessSolutioninteroperabilityn/aPayer
Patient Access API (Da Vinci)
Patient Access API (Da Vinci)

The Patient Access API is required by CMS 9115-F (Patient Access Rule) and CMS 0057-F (Interoperability & Prior Authorization Rule

PayerInteroperabilityBusinessSolutioninteroperabilityn/aPayer
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