CMS Interoperability: Seamless Continuity of Care for New Members Through Payer-to-Payer Exchange
The Payer-to-Payer Data Access API enables seamless health information exchange between current and previous/concurrent health plans when a member transitions coverage. Mandated under CMS Rule CMF 0057-F, impacted payers must implement and maintain a FHIR-based API that supports secure transmission of claims, encounter data, USCDI elements, and prior authorization information (excluding provider remittances and patient cost-sharing details).