Case Study: a leading American health insurance company achieves CMS interoperability compliance with Smile Digital Health

a leading american health insurance company meets CMS Patient Access deadlines with Smile Digital Health

a leading American health insurance company faced the challenge of meeting the new CMS Interoperability rule, which required implementing the FHIR standard for data exchange. While already managing a major data consolidation project, the company needed a solution to handle this new mandate without disrupting existing priorities. They contacted Smile Digital Health for its expertise and a cloud-based solution to achieve compliance.

Smile Digital Health successfully deployed its solution on Microsoft Azure, enabling the company to meet the first Patient Access API deadline and the subsequent Payer-to-Payer exchange mandate. The implementation provided the company with a unified, FHIR-based data fabric, which accelerated their cloud strategy and opened new opportunities for utilizing their clinical data. As a result, the company is now positioned to improve operational efficiency, enhance its HEDIS scores and STAR ratings, and pursue future initiatives like risk adjustment and prior authorization.