Compliance with CMS Mandate Achieved: Large Payer Leverages Azure Health Data Services


VNB Consulting utilized Azure Health Data Services to help a large payer integrate a patient access and provider directory API secured with AUTH 2.0 security, ensuring compliance with the CMS Mandate.

Customer Profile

Customer is a leading payer, serving more than 1.5 million members providing dental and vision insurance plans for individuals, employers and government programs. These plans give the power of a national network of providers backed by local service teams located in Iowa.

Customer Situation

The customer needed to implement the Patient Access API and Provider Directory API in order to comply with the CMS interoperability and patient access final rule, which was mandated in July 2021.

Our Solution Offering

Upon analyzing the internal EHR system of the customer and aligning the requirements with backend systems, our Integration team devised a solution to fulfil the CMS mandate using Microsoft Azure API for FHIR, Azure Logic Apps custom connectors and Azure Logic Apps. VNB suggested integrating with the EHR via Azure Logic Apps and creating a secure patient repository in Azure SQL to facilitate access to the Patient Access API. Utilizing Azure Logic Apps-based data feed, the necessary data for the Patient Access API and Provider Directory API was synchronised from the EHR to Azure API for FHIR. To ensure security, the team developed Azure Logic Apps-based front APIs which were secured with AUTH 2.0 authentication. These APIs retrieved patient access and provider directory data from Azure API for FHIR, seamlessly assisting the customer in meeting the CMS mandate. The team upheld the technical, content, and vocabulary standards outlined in the ONC 21st Century Cures Act final rule, adopted by CMS for supporting the two API policies. Implementation guides for Claims and Encounter Data, as well as Provider Directory Data, were adhered to, and the solution was evaluated against these standards.

Customer Benefits

  • The customer derived advantages from the solution by achieving CMS mandate compliance. Furthermore, it established a framework and solution architecture to address upcoming interoperability needs, facilitated by Azure API for FHIR.
  • The solution built on Azure API for FHIR enabled the customer to implement a FHIR Service, utilizing the scalability of a compliant cloud environment supported by Microsoft Azure.
  • The solution built on Azure also aided the customer's IT team in navigating the challenges of securely and dependably managing PHI within the cloud environment.

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