Pavel Smirnov, CEO of Health Samurai. CMS Interoperability and Patient Access final rule for health plans CMS has released Patient Access final rule for health plans. By July 1, 2021, health plans must allow their members to access their claims and encounter information over standards-based secure API (FHIR® 4.0.1). Pavel analyzed the rule in detail and share the checklist that any health plan can use. Then he explained the technology that Health Samurai has built to allow health plans comply with the rule.

1. CMS Interoperability and Patient Access final rule for health plans
Pavel Smirnov, Health Samurai

2. FHIR is our specialty. We have built FHIR
systems since 2012. Our mature and scalable
Aidbox FHIR platform powers more than 20
enterprise healthcare solutions that serve
millions of patients.
5 facts about us
16 years in Health IT
8 years contributing to FHIR
20+ FHIR projects in production
Own Aidbox FHIR Platform
1.5M+ patients in one installation

3. CMS Interoperability and Patient Access final rule
● CMS regulated Health Plans (345 organizations)
○ Patient Access API (applicable July 1, 2021)
○ Provider Directory API (applicable July 1, 2021)
○ Payer-to-Payer Data Exchange (applicable January 1, 2022)

6. How it has started - Blue Button 2.0
● CMS enabled Medicare beneficiaries to connect their Medicare claims
data to the applications
● Success story - more than 50 Apps
● It gave CMS a great reference

7. Control platform’s health,
security, and usage
Full-blown scalable FHIR
backend that can be easily
installed in your infrastructure
Designed for Health Plans. Flexible. Provides compliance.
FHIR Platform for Health Plans
Aidbox FHIR Server FHIR portal
Designed for members, health
plan administrators, and 3rd
party vendors for data access
management
Audit & Monitoring Module
1 2 3

8. Health Plan FHIR ecosystem
We can deploy Aidbox to the health plan existing
infrastructure side by side with other solutions.
Deployment flexibility
Aidbox Platform for health plans
can be deployed to any cloud or
on premises data center

9. How to prepare and load data?
CMS Requirements
● Claims & Encounter Data
● Clinical Data - USCDI v1
● IG CARIN
● FHIR US Core
● DaVinci IG
Aidbox offers per-built adapters to load claims and clinical data
and controls its structure and quality.

10. How to make data available?
CMS Requirements
● HL7 FHIR v4.0.1
● OAuth 2.0
● OpenID Connect
● SMART IG
We use your existing authorization server or bring our own.
Member portal and API manager work with a Single Sign-On.

11. How to manage and control access to data?
CMS Requirements
● Monitoring
● Audit Log
FHIR platform for health plans comes with dedicated portals for all
participants.

12. Pavel Smirnov, CEO, Health Samurai
Phone: (818) 731-1279
Email: pavel@health-samurai.io
https://www.linkedin.com/in/pavelsmirnoff/
https://twitter.com/paul_smirnoff