Member education

As part of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), payers must provide plain language resources to members at specific points of contact. 1upHealth provides template content for these resources which can be used as material on your website or in member communications. Engage the appropriate members of your organization for feedback, approval, and guidance on where these resources should be published.

The plain language resources must outline the following information:

• The benefits of Payer-to-payer API data exchange.

• The member's right to opt-in or withdraw consent.

• How members can take action. A guide on how to opt-in or opt-out satisfies this requirement.

The above resources must be available to members:

• when requesting member permission.

• annually through regular beneficiary communications.

• in an easily accessible location on the payer's public website.