The latest Proposed rule from CMS addressing Prior Authorization (December 13, 2022) also expands the Patient Access API and adds a Provider API.
Provider Access API and Patient Access API are two types of application programming interfaces (APIs) that allow different types of users to access member health information. Both are based on HL7 Fast Healthcare Interoperability Resource Specification (FHIR).
The Provider Access API allows healthcare providers to access health plan member data for Patients they have a treatment relationship with. This API will allow the Provider to retrieve data for multiple patients using the HL7 FHIRBulk API standard.
Patient Access API allows patients to access their own health data and other information related to their care. This type of API is typically used by healthcare organizations to allow patients to view their medical records. The proposed rule adds Prior Authorization information to the API.
In summary, Provider Access API is used by healthcare providers to access data for their patients, while Patient Access API is used by patients to access their own health data and other information related to their care.
To find out more about the implications of this proposed rule reach out to our Interoperability Advisory Service.