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Use case

Simplify CMS ACCESS Interoperability Requirements

The CMS ACCESS Model requires standardized, CMS-hosted data exchange. Redox connects you to every required pathway in one integration.

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What is CMS ACCESS?

ACCESS — Advancing Chronic Care with Effective, Scalable Solutions

CMS ACCESS is a 10-year, voluntary payment model launched by the Centers for Medicare & Medicaid Services (CMS). The program runs through June 30, 2036, and participants must be a Medicare Part B-enrolled provider or supplier with a designated Medicare-enrolled Medical Director.

Unlike traditional Medicare fee-for-service, ACCESS uses Outcome-Aligned Payments (OAPs): participants receive a fixed, per-patient payment for managing a beneficiary’s chronic conditions over a 12-month period, with full payment contingent on hitting track-specific clinical outcome targets — not on the volume of visits or services delivered.

CMS grouped qualifying chronic conditions into four clinical tracks based on clinical overlap, prevalence, and fit for technology-enabled care:

  • eCKM (Early Cardio-Kidney-Metabolic)
  • CKM (Cardio-Kidney-Metabolic)
  • MSK (Musculoskeletal)
  • BH (Behavioral Health)

How it works

Redox centralizes the integration work ACCESS requires so your team can focus on clinical outcomes instead of building and maintaining point-to-point connections to CMS, HIEs, and referring providers. Through one managed connection, Redox verifies beneficiary coverage and handles enrollment via CMS’s Eligibility & Alignment APIs, then submits baseline, quarterly, and end-of-period outcome measures through CMS’s FHIR-based reporting server — managing the payload structure and adapting as CMS’s API spec evolves.

Redox also connects you to the broader care network ACCESS requires: sharing standardized care updates with a beneficiary’s PCP at care initiation, completion, and escalation via DirectTrust, and standing up the bidirectional HIE connection (Carequality or TEFCA) ACCESS requires within 12 months — built on exchange relationships Redox already maintains, not new infrastructure.

  • CMS Eligibility & Alignment APIs: Check eligibility and enroll patients
  • CMS Data Reporting FHIR APIs: Report clinical measures at baseline and on a recurring cadence
  • Care Plan Sharing via DirectTrust: Share care updates with PCPs and referring clinicians
  • HIE Connectivity (Carequality or TEFCA): Connect to an HIE or trusted network within 12 months
  • CMS BCDA APIs (optional): Access historical claims data.

Meet CMS ACCESS interoperability requirements.