Welcome to Cloud Payer To Payer Service

The Cloud Payer To Payer service is a cloud solution that allows members to request their health information from their former payers when the patients move from one payer to another. The service acts as a hub that facilitates member data transfers between payers so that each payer can aggregate the health history of a newly enrolled member to create a cumulative medical record and make it available to the member as required by the final CMS Interoperability and Patient Access Rule.

The service offers a mechanism that automates member data transfers from one payer to another and helps ensure the continuity of patient treatment, eliminate the repetition of laboratory or diagnostic tests, previous therapies, and so on, and exchange data securely and effectively.

The Cloud Payer To Payer service offers two application interfaces: one for the members and one for the plan administrators.

With the member application, your members can:

  • Find their former payer among participating organizations or invite the payer to join the service;
  • Request their data from any of their former payers;
  • Track their request's status to be aware of the request completion.

With the plan admin application, you can:

  • Find the integration settings to configure the automatic interaction of the service with your system;
  • Share your FHIR endpoints configurations to enable the service to pull your former members' data;
  • Share your identity provider settings for member authentication;
  • View the list of organizations that can act as former payers for your members, and send requests to Edifecs to onboard former payers if they are not in the list;
  • View the list of all data requests with details and statuses.

At a high level, the flow of using the service is the following:

  1. A member signs in to the Cloud Payer To Payer service using their credentials from the member account they have in their new payer's system.
  2. In the list of payers that exposed their FHIR endpoints to the service, the member finds the organization profile of their former payer and raises a request.
  3. The member is prompted to authenticate with their credentials from the member account they have in their former payer's system.
  4. Upon successful authorization, the Cloud Payer To Payer service pulls all the data of this member in the form of a FHIR bundle from the FHIR server of the former payer and saves it to the repository allocated for the member's current payer.
  5. Once the request is completed, the current payer's system downloads the member data through SFTP from the repository to the location from where this data can be taken for further processing.