MedicaidAdministrativeMedium impact
CMS Interoperability and Patient Access Final Rule: Implications for CCOs
Oregon Health Plan·OR·Plan contract
Effective date
Jan 1, 2021
We identified it
Jun 20, 2026
Summary
The CMS Interoperability and Patient Access Final Rule requires Coordinated Care Organizations (CCOs) to implement standardized APIs for patient access to claims data, public provider directories, and payer-to-payer data exchange. This affects how patient health information is shared electronically and may impact billing workflows for practices working with Medicaid managed care plans.
Action Required
By July 1, 2021: Billing teams working with Oregon Medicaid CCOs should verify their practice information (names, addresses, phone numbers, specialty) is accurate in provider directories as this data will be publicly available via APIs. Contact CCO representatives to confirm provider directory accuracy and understand any new patient data access processes that may affect billing workflows.