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Optum Interoperability and Patient Access Services

Put patients first by facilitating access to their health care data through one common standard. 


Putting the patient first

The CMS Interoperability and Patient Access rule represents a milestone in advancing interoperability and efficient data exchange. The rule establishes the Health Level 7® (HL7) Fast Healthcare Interoperability Resources® (FHIR) Release 4.0.1 as the standard for data exchange through open APIs.

This enables HIPAA-compliant partner applications to provide patients timely access to their health records.

Meeting compliance with flexibility and scale

Optum® Interoperability and Patient Access Services can help Medicaid agencies meet compliance for all components of the Interoperability and Patient Access final rule.

Our solution enables states to:

  • Give Medicaid members electronic access to health data and medical claims via secure, FHIR standards-based APIs
  • Make provider directories available externally
  • Exchange patient clinical data between payers at a patient's request

Addressing your agency's unique needs

Our approach allows for flexible implementation based on your state environment. We can provide the whole solution, augment where there is a gap, and scale our solution for the largest Medicaid infrastructures. We can provide one or all of the following components.

API translation and mapping services: Since state systems may not store data in the correct standards, we can help translate and map data to FHIR standards.

Storage in an accessible format: Data can be stored in an Optum Patient Data solution, which is accessible via the approved and secure APIs.

Access management: This is a critical component for security and includes identity access control, the ability to delegate who can see your data, and data transfer between entities.

Unlocking the value of interoperability

Once implemented, it can help to improve the value of modularity while accelerating additional value when your agency is ready. 

Data are key assets to an enterprise. A canonical data set combining claims/encounters, clinical and formulary data creates analytic opportunities to improve the insights about operations and Medicaid populations. This is the strength of Optum.

Quality and reliability are crucial. Our accelerators and experience with data integration, quality assurance and health plan and Medicaid operations enable the delivery of high-quality and reliable solutions.

Achieving your goals is our No. 1 priority. Our approach is driven by your needs. We assess your agency's goals and technical requirements to deliver a solution that is right for you.