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Payer-to-payer data exchange made easy

The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) marks significant progress toward ensuring that payers and providers have access to member data for informed decision-making. 

With the rule going into effect January 1, 2027, payers need the most effective and efficient way to send and receive member data. Availity’s Payer-to-Payer Hub allows them to easily establish secure connections in accordance with the CMS mandate.

Establish a one-to-many connection point with Availity

Building and maintaining individual connections with each payer is costly and time-consuming. Availity accelerates interoperability and streamlines the payer-to-payer API data exchange process by allowing payers to establish one connection with Availity, significantly reducing the operational and security burden.

Seamlessly send and receive member data

Without the proper framework for facilitating data exchange, payers will find it difficult to respond to information requests or process data from other payers. Payer-to-Payer Hub allows payers to leverage a consistent process that supports all necessary components of the mandate, including:

  • Request member data from the member’s previous plan
  • Conduct member matching to validate and identify the member
  • Obtain security clearance to access the member’s data 
  • Seamlessly receive and manage member data

Customize care management programs and support analytics

Availity’s one-to-many connectivity with Payer-to-Payer Hub paves the way for payer value that extends beyond just meeting the mandate. This includes enhancing overall member satisfaction, leveraging comprehensive health insights for predictive analytics, and optimizing care coordination and health outcomes.  

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