Talk to Smile at eSolutions Xchange 2025

Smile Digital Health is proud to join Blue Cross Blue Shield Plans and other leading payers at this year’s eSolutions Xchange. 2025 is a pivotal year for healthcare. For US Payers there are several overlapping priorities (and opportunities) as healthcare technology transforms:

These priorities have operational, financial, clinical and technological implications, as well they significantly impact patient/ member outcomes, and payer-provider relationship.

Smile’s FHIR and CQL engine powers over 11 Blue Cross Blue Shield (BCBS) clients and the BCBS Association, enabling them to go beyond mandates, optimize operations and improve member care with real-time data, actionable insights, and future-ready solutions. Our solutions touch over 100 million American lives.

✓ Meet all CMS-0057-F Final Rule requirements, including Prior Authorization APIs, Payer-to-Payer, and Patient Access
✓ Achieve 80% real-time PA adjudication through our FHIR and CQL engine and rules-based automation
✓ Rely on transparent, auditable prior authorization decisions
✓ Reduce operational costs by up to 70% by minimizing care delays and administrative burden
✓ Built-in consent and audit controls for secure data exchange

✓ Eliminate labour-intensive, time-consuming workflows with an engine that automatically calculates real-time HEDIS measures 
✓ Phase out hybrid reporting, and phase in fully automated FHIR-native data submissions from a single source-of-truth repository
✓ Run real-time care gaps assessment, implement workflows to close gaps proactively, increasing their STAR Ratings
✓ Start parallel testing for at least 35 NCQA Validated measures (a requirement before receiving submittable HEDIS Rates) for the 2025 measurement year
✓ Gain competitive quality advantage today by piloting digital reporting earlier