Endpoint Directory Supports Payer Interoperability Compliance

CAQH has officially launched the CAQH Endpoint Directory to support payers with interoperability compliance as they prepare for approaching deadlines in 2021 and 2022.

“The need for the endpoint directory was a barrier to scale that the ONC FAST group had identified,” April Todd, senior vice president of the Committee on Operating Rules for Information Exchange (CORE) and explorations at the Council for Affordable Quality Healthcare (CAQH), explained.

“Given the position we're at in the industry, with the connections that we have with plans and providers, we thought that we could fill this space quite nicely by helping to address one of those barriers by bringing an endpoint directory to really help the industry interact more effectively.”

The organization originally announced that it would be releasing this solution in October 2020 in order to enable the nearly 300,000 connections that need to occur between payers, app vendors, and Medicaid programs.

Following this announcement, CAQH conducted a successful beta test of the endpoint directory in December 2020 and January 2021.

“Generally, the feedback that we got from the beta test helped us make the endpoint directory a little more user-friendly,” Todd said. “As part of the beta test, we got confirmation that the functionality that was in there was what people were looking to see.”

The endpoint directory is intended to be a two-way street of information—payers will provide information for app vendors and app vendors will provide information for payers.

One of the lingering questions when CAQH announced the endpoint directory in 2020 was what facts the organization would request from vendors.

Two motivations guided the organization’s final decision regarding the questions that the directory would pose to vendors. First, CAQH determined to request information that would help payers assess security risks and, second, it would ask for information that payers would need to pass along to members if they chose to collaborate with the app vendor.

With these in mind, the directory asks app vendors to submit privacy and security practices, divulge identity information that verifies the vendor’s validity as an organization, and share what they as a vendor intend to do with the data that they receive.

The vendors must also put their apps through a CAQH test that establishes how the apps ingest information and how they tap into payer information.

From payers, the organization requests information about their endpoint, asking how it is structured and testing it to ensure that it functions in the appropriate way.

Todd anticipated that the directory would continue to undergo updates and changes in the future. In fact, the beta test already revealed one potential adjustment. Given the impending 2022 interoperability deadline, users may wish to leverage the directory as a tool to help fulfill specific payer-to-payer data exchange requirements such as member matching.

“The assumption that has been in the market today is that members know what their past health plan was that they maybe kept their identification card,” Todd shared. “What we've heard from plans is that oftentimes members really don't know what their past coverage was. We have some data assets from other solutions that could potentially be helpful in that.”

CAQH might also add provider endpoints to the directory to help payers and providers connect with each other as well as to connect app vendors with providers. Todd indicated that the organization is currently exploring that possibility.

Ultimately, however, the goal for the directory has been to enable payers as they prepare for the interoperability requirements. Originally CMS finalized the rule under the Trump administration in March 2020. Since then, the deadline has been extended to July 1, 2021 due to the impacts of the coronavirus pandemic.

The rule requires payers to send patient data to the secure apps of patients’ choosing. Information blocking of any kind is prohibited. Payers must partner with apps to provide patients with access to their data, but payers cannot require patients to download the designated app.

Eventually, payers will have to be able to share data not only with app vendors but also with other payers whenever a member transitions her coverage. Payers will not have to comply with this regulation until 2022.

“In our conversation with payers, many of them are planning and doing everything they can to be ready for July 1,” Todd said. “We know there's some variability out there and we're hoping that by having the endpoint directory up and running, and the ability to support the apps, and the payers in doing this that, it will make it a little easier for the plans to be ready by July.”

As the clock winds down to the July 1 deadline, Todd urged payers to be smart about how they direct their energies and to take advantage of the resources available to them.

“There are some things where payers don't have to recreate the wheel,” Todd emphasized.

“They don't need to come up with all of their own questions for engaging with the app vendors. They don't need to set up their own testing mechanisms for them. There's been a lot of work within the industry amongst FHIR at Scale Task Force (FAST), the CARIN Alliance, DaVinci, and our endpoint directory as well that have created some industry standard ways of doing things that payers can sign onto. That can just take one hurdle off their plate and they can focus on some of the harder stuff around the FHIR circuit work.”