CMS Interoperability & HL7 FHIR R4 Integration Suite
Unlocking healthcare data liquidity through open standards, federal compliance (CMS-0057-F), and automated prior authorization pipelines.
Federal Mandate Alignment: CMS-0057-F & ONC HTI-1
The Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F) mandates that Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, and Medicaid managed care plans implement modern HL7 FHIR-based APIs. EA Horizon’s platform is built natively on these federal specifications, ensuring providers and payers achieve full compliance while streamlining administrative workflows.
The HL7 FHIR R4 Architectural Foundation
Unlike legacy healthcare systems that rely on batch flat files or brittle HL7 v2 interfaces, EA Horizon’s Santé platform employs a modern RESTful FHIR R4 infrastructure with granular resource mapping. Every clinical encounter, patient demographic, coverage policy, and prior authorization request is represented as a standards-compliant FHIR resource.
- Patient & Coverage Resources: Standardized FHIR Patient, Coverage, and Organization resources enabling real-time identity matching and insurance verification.
- Clinical Resources (USCDI v3/v4): Encounter, Condition, Procedure, Observation, and CarePlan resources adhering to US Core Implementation Guides.
- Prior Authorization Suite: Claim, ClaimResponse, and Task resources orchestrating automated prior authorization submissions and approvals.
Automating Prior Authorizations via Da Vinci Burden Reduction
EA Horizon implements the complete HL7 Da Vinci Burden Reduction framework to eliminate the friction and delays historically associated with medical prior authorizations:
- Coverage Requirements Discovery (CRD): Hooks directly into clinical charting workflows to notify providers immediately if prior authorization is required for ordered services.
- Documentation Templates and Rules (DTR): Uses SMART-on-FHIR and Clinical Quality Language (CQL) to pre-populate required documentation templates directly from the patient’s clinical record.
- Prior Authorization Support (PAS): Submits the authorization request electronically to payor systems using FHIR, enabling real-time or rapid automated adjudication.
Turnkey Hospital EHR Integration
El middleware de interoperabilidad de EA Horizon proporciona conectores de integración certificados para los principales sistemas de registros médicos electrónicos del país:
- Sistemas épicos:Integración bidireccional de FHIR R4 y SMART en Epic para derivaciones de pacientes, transición de resúmenes de atención y ejecución de órdenes clínicas.
- Salud de Oracle (Cerner):Integración perfecta con las API de Cerner Millennium e Ignite para coordinar y programar feeds de cuidados post-agudos en tiempo real.
- MEDITECH y otros:Conectividad RESTful FHIR API y procesamiento de documentos de transición C-CDA para sistemas de salud comunitarios.
Estándares y especificaciones de interoperabilidad compatibles
Conéctese con nuestro equipo de ingeniería de interoperabilidad
¿Quiere integrar Santé con el EHR de su hospital o probar nuestros puntos finales FHIR? Póngase en contacto con nuestros arquitectos de integración en [email protected].