CMS Suite

JSON twin: https://www.healthaidb.com/software/cms-suite.json

Company Name

Smile Digital Health

Product URL

https://www.smiledigitalhealth.com/solution/cms-suite

Company URL

https://www.smiledigitalhealth.com/

Categories

• administrative Operations
• clinical Care
• patient Facing
• compliance Management
• data Integration
• Administrative
• Clinical
• Compliance
• Interoperability

Summary

Smile Digital Health's CMS Suite is a comprehensive solution designed to help payers achieve compliance with CMS-0057-F regulations, streamlining processes across the payer network and enhancing data interoperability.

Description

Smile Digital Health's CMS Suite offers a flexible and comprehensive solution that enables payers to meet the complex requirements of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). The suite includes modules for Electronic Prior Authorization (ePA), Payer-to-Payer (P2P) data exchange, Patient Access, Provider Access, and Provider Directory, all built upon a FHIR-native Health Data Platform. These modules automate workflows, reduce operational costs, and improve patient care by providing real-time, event-driven services. The suite is highly customizable, scalable, and designed for future upgrades, ensuring long-term compliance and operational efficiency. Smile Digital Health has a proven track record, having implemented CMS-9115-F requirements for over 20 payers, impacting over 100 million US lives, and is recognized as a leader in the field of healthcare interoperability.

Api Available

yes

Certifications

• HITRUST r2
• SOC 2 Type II
• ISO/IEC 27001:2013
• ISO/IEC 27017
• ISO/IEC 27018
• ISO 13485:2016
• ONC Drummond certification (FHIR APIs)

Company Founding

2015

Company Offices

• United States
• Canada

Compliance

• HIPAA
• HITRUST
• SOC 2 Type II
• ISO/IEC 27001
• ISO/IEC 27017
• ISO/IEC 27018
• ISO 13485
• ONC (Drummond / ONC tooling compliance)

Customers

Data Residency

US and Canada; multi-region cloud hosting (customer region options)

Data Standards

• FHIR
• HL7 v2
• HL7 v3
• CDA
• SMART on FHIR
• SNOMED CT
• ICD-10

Deployment Model

• SaaS
• on_prem
• hybrid
• cloud-hosted

Features

• FHIR-native data repository
• High-velocity, mega-volume data ingestion
• Data normalization & transformation (unstructured->FHIR)
• Support for multiple FHIR versions
• HL7 v2 / v3 and CDA ingestion
• Master Data Management (MDM)
• CDA Exchange+ (CDA handling)
• Real-time export / RTE
• SMART on FHIR support
• Advanced audit logging
• Federated identity & access management
• Reporting & analytics
• Modular architecture (activatable modules)
• APIs for third‑party apps and CDSS
• Patient access / consumer data exchange

Id

SW2882

Integration Partners

Integrations

• SMART on FHIR apps
• Apple Health
• HIE networks
• Third‑party clinical decision support systems
• Analytics platforms
• Payer systems (CMS-focused integrations)
• PatientShare (Smile solution)
• CDA sources / legacy EHR feeds

Languages Supported

• English

Last Updated

2025-10-11

License

commercial

Market Segment

• enterprise
• smb

Optional Modules

• Smile Prior Authorization
• Smile Payer To Payer
• Smile Payer Member
• Smile appSphere

Os Platforms

• Web
• iOS
• Android
• Windows
• macOS
• Linux

Pricing Details

Contact vendor for pricing information.

Pricing Model

subscription

Privacy Features

• BAA available
• consent mgmt
• anonymization
• data minimization

Product Code

SW2882

Product Name

CMS Suite

Ratings

Regions Available

• United States

Related Urls

Release Year

Security Features

• Encryption
• RBAC
• SSO/SAML
• audit logs
• 2FA
• DLP

Specialties

• Healthcare Interoperability
• Data Exchange
• Prior Authorization
• Patient Data Access
• Provider Data Access

Support Channels

System Requirements

Major OS/DB/hardware needs, or empty if SaaS-only

Target Users

• payers
• healthcare providers
• patients
• healthcare administrators

Training Options

Type

product

User Reviews

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "CMS Suite",
  "company_name": "Smile Digital Health",
  "product_url": "https://www.smiledigitalhealth.com/solution/cms-suite",
  "company_url": "https://www.smiledigitalhealth.com/",
  "related_urls": [],
  "product_code": "SW2882",
  "summary": "Smile Digital Health's CMS Suite is a comprehensive solution designed to help payers achieve compliance with CMS-0057-F regulations, streamlining processes across the payer network and enhancing data interoperability.",
  "description": "Smile Digital Health's CMS Suite offers a flexible and comprehensive solution that enables payers to meet the complex requirements of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). The suite includes modules for Electronic Prior Authorization (ePA), Payer-to-Payer (P2P) data exchange, Patient Access, Provider Access, and Provider Directory, all built upon a FHIR-native Health Data Platform. These modules automate workflows, reduce operational costs, and improve patient care by providing real-time, event-driven services. The suite is highly customizable, scalable, and designed for future upgrades, ensuring long-term compliance and operational efficiency. Smile Digital Health has a proven track record, having implemented CMS-9115-F requirements for over 20 payers, impacting over 100 million US lives, and is recognized as a leader in the field of healthcare interoperability.",
  "categories": [
    "administrative Operations",
    "clinical Care",
    "patient Facing",
    "compliance Management",
    "data Integration",
    "Administrative",
    "Clinical",
    "Patient-facing",
    "Compliance",
    "Interoperability"
  ],
  "market_segment": [
    "enterprise",
    "smb"
  ],
  "target_users": [
    "payers",
    "healthcare providers",
    "patients",
    "healthcare administrators"
  ],
  "specialties": [
    "Healthcare Interoperability",
    "Data Exchange",
    "Prior Authorization",
    "Patient Data Access",
    "Provider Data Access"
  ],
  "regions_available": [
    "United States"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "subscription",
  "pricing_details": "Contact vendor for pricing information.",
  "license": "commercial",
  "company_offices": [
    "United States",
    "Canada"
  ],
  "company_founding": "2015",
  "deployment_model": [
    "SaaS",
    "on_prem",
    "hybrid",
    "cloud-hosted"
  ],
  "os_platforms": [
    "Web",
    "iOS",
    "Android",
    "Windows",
    "macOS",
    "Linux"
  ],
  "features": [
    "FHIR-native data repository",
    "High-velocity, mega-volume data ingestion",
    "Data normalization & transformation (unstructured->FHIR)",
    "Support for multiple FHIR versions",
    "HL7 v2 / v3 and CDA ingestion",
    "Master Data Management (MDM)",
    "CDA Exchange+ (CDA handling)",
    "Real-time export / RTE",
    "SMART on FHIR support",
    "Advanced audit logging",
    "Federated identity & access management",
    "Reporting & analytics",
    "Modular architecture (activatable modules)",
    "APIs for third‑party apps and CDSS",
    "Patient access / consumer data exchange"
  ],
  "optional_modules": [
    "Smile Prior Authorization",
    "Smile Payer To Payer",
    "Smile Payer Member",
    "Smile appSphere"
  ],
  "integrations": [
    "SMART on FHIR apps",
    "Apple Health",
    "HIE networks",
    "Third‑party clinical decision support systems",
    "Analytics platforms",
    "Payer systems (CMS-focused integrations)",
    "PatientShare (Smile solution)",
    "CDA sources / legacy EHR feeds"
  ],
  "data_standards": [
    "FHIR",
    "HL7 v2",
    "HL7 v3",
    "CDA",
    "SMART on FHIR",
    "SNOMED CT",
    "ICD-10"
  ],
  "api_available": "yes",
  "system_requirements": "Major OS/DB/hardware needs, or empty if SaaS-only",
  "compliance": [
    "HIPAA",
    "HITRUST",
    "SOC 2 Type II",
    "ISO/IEC 27001",
    "ISO/IEC 27017",
    "ISO/IEC 27018",
    "ISO 13485",
    "ONC (Drummond / ONC tooling compliance)"
  ],
  "certifications": [
    "HITRUST r2",
    "SOC 2 Type II",
    "ISO/IEC 27001:2013",
    "ISO/IEC 27017",
    "ISO/IEC 27018",
    "ISO 13485:2016",
    "ONC Drummond certification (FHIR APIs)"
  ],
  "security_features": [
    "Encryption",
    "RBAC",
    "SSO/SAML",
    "audit logs",
    "2FA",
    "DLP"
  ],
  "privacy_features": [
    "BAA available",
    "consent mgmt",
    "anonymization",
    "data minimization"
  ],
  "data_residency": "US and Canada; multi-region cloud hosting (customer region options)",
  "customers": [],
  "user_reviews": [],
  "ratings": [],
  "support_channels": [],
  "training_options": [],
  "release_year": "",
  "integration_partners": [],
  "id": "SW2882",
  "slug": "cms-suite",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/cms-suite.json"
  }
}