On this page:
  • Explanation
  • 70.0 Overview
  • 70.1 Actors, Roles & Data Flow
  • 70.2 Data Scope, Use Cases and Timeliness
  • 70.3 Security
  • 70.4 Consent Management
  • 70.5 Glossary of Terms
    • 70.1    Actors, Roles & Data Flow   
    Table of Contents

    Overview

    70.0.1Provider Access API

     

    The Provider Access API enables in-network providers to securely retrieve up-to-date patient data from payer systems for treatment purposes. It allows providers to view a member’s complete health history—including claims, encounters, clinical data, and prior authorization summaries—helping improve care coordination and continuity.

    70.0.2Regulatory Context

     

    The CMS Interoperability and Prior Authorization Final Rule CMS-0057-F mandates payers to enable provider access APIs by January 1, 2027, ensuring that providers can view a member’s complete and up-to-date record. This aligns with the broader goal of improving transparency and interoperability in healthcare systems.

    70.0.3Solution Module

     

    The Provider Access API is implemented within the Da Vinci Data Exchange module. The module must be configured and enabled, and it must be connected to the payer FHIR endpoint to provide secure access to provider-attributed patient data.

    70.0.4Standards & Technology

     

    The API is built on HL7 FHIR R4 and follows the Da Vinci Payer Data Exchange STU 2.1.0 Implementation Guide.

  • Explanation
  • 70.0 Overview
  • 70.1 Actors, Roles & Data Flow
  • 70.2 Data Scope, Use Cases and Timeliness
  • 70.3 Security
  • 70.4 Consent Management
  • 70.5 Glossary of Terms
    • 70.1    Actors, Roles & Data Flow