Insurance Technology

Payers achieve CMS Interoperability compliance and complete member visibility with Redox platform

Redox announces their payer-specific interoperability solution. This expansion of Redox's platform allows payers to meet current and future CMS regulatory requirements while also enabling connections with providers, partners and vendors. As a result, payers can access the data necessary to unlock administrative efficiencies, understand the breadth of member journeys, and improve care.

The CMS Interoperability and Patient Access final rule mandates that payers enable patients to access payer-hosted clinical and claims data upon a patient's request via third-party applications. Payers must also make provider directories publicly available for third-party applications. In 2022, those mandates will expand such that payers must exchange data with other payers at a patient's request. Further proposed are additional interoperability mandates focused on providing electronic access to prior authorization requests.

Redox connects payers to the data and applications needed to keep pace with a rapidly shifting healthcare and technology landscape.   

Redox solves data interoperability for:
  • Electronic prior authorization Connect providers and payers to streamline the $30 billion existing prior authorization process to reduce administrative waste.
  • Closing Care Gaps Receive clinical information for your member population and send insights back to providers to ensure best practice guidelines are met and that all care team members are in sync.
  • Integrating digital health solutions Power data exchange between the growing ecosystem of third-party applications used in managing patient populations and individual patient health.
  • Direct Scheduling Build superior member experiences by enabling real-time scheduling with any provider in your network.

"Large payers already know that Redox has the most extensive network in the healthcare data interoperability space, and they are using Redox's platform as a strategic advantage, Although the mandates aren't yet urgent, payers are moving quickly to adopt them because those payers are already benefiting from its efficiencies."   

- Garrett Rhodes, Product Manager for Payers at Redox.

About Redox
Redox accelerates the development and distribution of healthcare software solutions with a full-service integration platform to securely and efficiently exchange healthcare data. With just one connection, data can be transmitted across a growing network of 1,700+ healthcare delivery organizations and 300 independent software vendors. Members of the Redox Network exchange more than 20 million patient records per day, leveraging a single data standard compatible with more than 85 electronic health record systems. Redox exists to make healthcare data useful and every patient's experience a little bit better.



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