ClientUS elder care provider
IndustryHealthcare
ProductsHealth Cloud
Headline result2CMS models automated (GUIDE, ACCESS)
The challenge
The provider takes part in the CMS GUIDE Model for dementia care and the ACCESS Model. Submissions had to match changing specifications exactly, and rejected payloads cost time and revenue.
What we did
- Built a JSON builder for GUIDE submissions, updated for new mandatory fields
- Built a FHIR R4 integration for ACCESS: Patient resources and QuestionnaireResponse
- Mapped Salesforce picklists to CMS value sets and fixed closed-slice compliance issues
- Added CMS billing rules (G0529 tier validation, six-month new-patient window)
Results
- Submissions generated from Salesforce instead of by hand
- Rejected (HTTP 400) payloads fixed at the source
- Billing rules enforced before claims go out
Technology
ApexFHIR R4RESTOAuthCustom MetadataEDI 837
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