Payer interoperability platform
Payers can fast-track CMS Interoperability compliance solutions today with a platform that can flex and scale as business objectives, technology, and legislation change.
Redox® is the most connected healthcare interoperability platform on the market. Connect once to enable all your data exchange needs with providers, HIEs, 3rd party applications, other payers/health plans, and more. With existing connections to over 1700 provider organizations and 300 healthcare products, Redox will connect you faster while also reducing the burden for both you and your partners.
For payers, interoperability enables new services and products to improve the health of your business and your members in an increasingly digital world.
- Connect to external partners and understand member health and behavior.
- Connect patient data across internal services to make better decisions and fill gaps in care.
Accelerate compliance today
CMS Interoperability mandates have opened a window of opportunity (and okay, maybe also a can of worms). Interoperability won’t come easy, but experts agree that the Payers that embrace this moment to imagine and innovate will be well served. Redox helps you overcome integration complexity and fast track to benefits, regardless of whether your solutions are homegrown or purchased from a vendor.
Payer-to-payer data exchange
While CMS may not be enforcing the January 2022 deadline, a requirement to exchange data with other payers is coming. Will you be ready? Redox’s networked solution supports secure multi-payer data exchange in FHIR or in any ONC approved format. The Redox network already includes 12+ Payers with more on the near-term horizon.
Electronic prior authorization
There is a growing number of outstanding prior authorization and utilization management solutions on the market today. Redox can connect any of them, or your home-grown solution, enabling a truly end-to-end prior authorization process. The promise of reduced administrative burden for you and your provider partners, and improved experiences for your members is closer than you think. Check out our FHIR API References to learn more about how Redox uses the DaVinci PAS profiles to support prior authorization.
CMS Interoperability regulations will require the adoption of FHIR throughout the industry. Redox is committed to helping payers, providers and others comply with the mandates through our Redox FHIR APIs. We have built a Payer FHIR API that embraces the Da Vinci Prior Authorization Implementation Guide. More functionality is on the way as we continue to invest in expanding our FHIR capabilities and standards are finalized.
While we will help you to fully adopt FHIR, we know the transition to FHIR will take the industry several years. In the meantime, we will continue to connect you to all ONC-approved legacy standards (X12, NCPDP, HL7v2, etc.) for both incoming and outgoing messages, and allow you to interact with them through a single FHIR API. We will manage the complexity so you don’t have to.
Connect to healthcare’s tomorrow
In an era of rapid technology advancement, you should not delay opportunities to improve member experiences or the quality of their care due to fear of technical debt or lengthy integrations. Redox helps you spend more time innovating and less time integrating as your needs, technology, and the healthcare landscape change.
Build a full picture of your members
Redox ingests and normalizes data from any ONC-approved format from all your partners. Clinical summary, medication, results, clinical decision, notes, patient admin, referral and 15 other unique Redox data models will help you create a full, longitudinal view of your members and their health – you will understand preferences, improve experiences, and increase member retention to fuel your growth in an increasingly competitive market.
Get more quality out of your quality improvement initiatives
Redox facilitates timely bi-directional data exchange with providers to enhance communication and collaboration. You receive provider data to improve decision making and establish more personalized member care plans. Providers receive and review your insights directly in the EHR at the point of care so they can deliver the right care, at the right time. Working together to close care gaps increases the impact of your managed care and value-based care programs to improve your HEDIS/STAR ratings.
Find partners already connected to Redox
Search the network
1800+
Provider Orgs Connected to Redox
300+
Healthcare Products in the Redox Network
85+
Compatible EHR Systems
Resources for Payers
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Why Redox?
Once you connect with Redox you can be confident that you have an expert integration partner who is committed to accelerating your integrations, reducing overhead, and navigating complexity. We have an A rating from KLAS Research and will support you through each step of the connection process.
Prepare
- Project Planning
- Scoping & Implementation
- Proactive Monitoring & Alerts
- Tier 1 Support
Execute
- Interface Mappings
- Issue Resolution
- EHR Upgrades
- Workflow Optimization
Maintain
- VPN Heartbeat Monitoring
- Certification Management
- Automated Message Retriggers
- 24/7 On-call Engineers
Security
Keeping member health information secure is our highest priority and we are committed to continually enhancing our security as technology changes and our infrastructure evolves. We are HIPAA and SOC II compliant. Learn more about Redox’s security-first culture.