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Payer-to-Payer Member Matching in Healthcare Interoperability: Are You Ready?
How can your organization best prepare for the looming January 1, 2022 Payer-to-Payer health information deadline?
May 06, 2021
Our last blog on The Cures Act and the rapidly approaching July 2021 compliance deadline made mention of another important milestone: January 1, 2022. January 1 signifies the time when the requirements for Payer-to-Payer health information exchange goes into effect and member matching becomes a critical component of interoperability.
But what is member matching? And why is it so important?
Most payers are accustomed to handling multiple data transaction sets with member-specific information coming into their respective infrastructures. Typically, if some of this information comes from one of their partners, there is an established means of tying that information back to a specific member via the use of an agreed-upon unique identifier, often defined internally and augmented with other data fields. Payers are apt to find that they will need to up their game on identifying and verifying members to support new healthcare information exchange capabilities once this new deadline arrives.
Come January 1, payers will begin receiving additional information from outside sources — namely other payers that formerly had a relationship with their members and who may have requested their information be sent. Because these payers aren’t existing partners, they won’t necessarily know specific member identifiers and will need to match a member transaction in an API request to a member on file. Without the right data and business logic to match member data, payers may not be able to respond to requests for information or receive and process information from another payer without introducing privacy concerns and risks. This could lead to delays in treatment reviews and approvals, or other important decisions that may be reliant on this data.
As we mentioned in the previous blog, it is our hope that many of you have a plan and strategy in place for how you’ll handle member matching for interoperability. Payers will need to consider the guidelines available in the industry, including member matching information available from CMS Office of the National Coordinator and the Sequoia Project. Some of you may have already begun implementation, but for others, the question might remain: How do payers properly identify member data points and link the data to the correct member?
Organizations will be faced with build-or-buy decisions when it comes to member matching technology. Multiple application solutions exist in industry and there are several enablers and tools available should an organization decide to develop their own solution. Regardless of the decision the organization makes, having accurate member data becomes a pre-requisite to perform matching. Data management solutions like Master Data Management can help ensure data quality and accuracy.
Whether its data-management-related activities or overall healthcare interoperability expertise, preparation and implementation for the patient matching requirement may seem daunting, but IQVIA is here to help.
Our data management and interoperability experts are well-versed in data quality and data mastering techniques as well as the new interoperability mandates. Healthcare Technology Consultants from IQVIA are more than ready to help guide you through the process of implementation, be it with one of the numerous available software solutions or with one of your own design.
As we work our way out of the pandemic, easy and accurate sharing of member information has never been more critical. If you’re not ready for the Payer-to-Payer healthcare information exchange coming in January 2022, now is the time to start.
Catch up on the Cures Act
Are you ready for July 1, 2021?