Return to flip book view

The Health Data Platform for Standardized, Structured,and Computable DataTake control of your healthcare data withthe Smile Health Data Platform. Smile’sPlatform transforms your healthcare datainto a powerful tool for driving better clinicaloutcomes, streamlining operations, andensuring compliance. Modernize yoursystems and turn legacy data into future-ready FHIR resources with the mostcomprehensive platform built for healthcareinteroperability, scalability, and security.Why Smile Health DataPlatform?Health Experts You Can Trust Our experts can guide you through every phase ofyour health data modernization strategy. Fromplanning to implementation, we ensure a smoothand successful transformation that sets yourorganization up for long-term success with themost comprehensive support for the FHIRstandard.Health Information You Can Trust Smile’s Platform ensures your data is standardizedand structured according to global healthcarestandards, making it accurate, real- time, andactionable for critical decisions that drive betterclinical outcomes.www.smiledigitalhealth.com | sales@smiledigitalhealth.com | 877-537-3343Copyright © 2025 Smile CDR Inc. (doing business as Smile Digital Health).Integrate andnormalize fragmenteddata from legacy systemsConsistently import disparate data formats such as HL7v2, CSV, and CDA into FHIR-compliant resources for a unified, actionable data source.Simplify regulatory complianceEnsure regulatory compliance with built in support for HIPAA, GDPR, and HITRUST® standards plus consent management, audittrails, and reporting. Ensure secure accessControl and manage data security with advanced tools, including encryption, multi-factor authentication, andconsent management.Build for the futureLeverage Smile’s open architecture and open APIs to ensure your platform aligns with long-term goals, providing extensibility and customization without being confined to proprietary systems.When implementing a data modernization strategy, healthcare organizations face challenges such as fragmented data, outdated legacy systems, and evolving regulatory requirements. The Smile Health DataPlatform provides solutions that transform these challenges into opportunities:Smile Health Data Platform: The Foundationof Your Modernization StrategyAddressing Healthcare’s Data Modernization Challenges

Native FHIR-Based Data Repository:Smile offers full support for multipleFHIR versions, ensuring your data isstructured for standardized, secureexchange tailored to your needs.Built-In Security & Privacy: Protect sensitive health data with AES-256 encryption, multi-factor authentication (MFA), and role-based access control (RBAC), ensuring compliance with global standards.Real-Time Data Processing: Access immediate insights through real-time data transformation, optimizing clinical workflows and decision-making.Scalability for Every Organization:The Smile Platform scaleseffortlessly to support small clinicsand large health systems, withoutcompromising on performance.Seamless Integration with External Systems: Full API support allows integration with third-party systems, clinical decision support tools, and analytics platforms.Contact us todayto learn how Smilecan revolutionize yourdata strategy. www.smiledigitalhealth.com | sales@smiledigitalhealth.com | 877-537-3343Copyright © 2025 Smile CDR Inc. (doing business as Smile Digital Health).The Smile Health Data Platform is your foundationfor a future-ready healthcare infrastructure.Drive better care, smarter decisions, and strongeroutcomes with the most secure, flexible, andinteroperable health data platform available.Beyond these core capabilities, the Smile Health Data Platform delivers bulk FHIR import forstreamlined data ingestion, advanced audit logging to track every system interaction, andcomprehensive reporting and analytics tools to help you make data-driven decisions. With supportfor multi-cloud deployment and federated identity management, the Smile Platform ensures thatyour organization’s data infrastructure is flexible, secure, and ready to scale alongside your needs.Smile Health Data Platform: The Foundationof Your Modernization StrategyKey Capabilities for Healthcare Transformation

Smile dQM HEDIS SolutionThe Healthcare Eectiveness Data and Information Set (HEDIS), developed by the National Committee for Quality Assurance (NCQA), is the nation’s most widely recognized set of digital quality measures (dQM). Used by over 90% of America’s health plans, HEDIS provides a standardized framework to assess performance across key aspects of care and service. These measures are vital for ensuring patients receive high-quality care, driving continuous quality improvement, and empowering consumers to make informed healthcare decisions. However, there are still some challenges with tradition HEDIS quality measurement reporting: Introducing HEDIS Digital Content Services and Smile dQMTo address these challenges, NCQA introduced the HEDIS Digital Content Services solution, oering an open-standard, FHIR and CQL-based approach for eciently managing and updating HEDIS dQMs. This service provides standardized, machine-readable HEDIS measures and guidelines, ensuring access to the most current specications. This allows for a stronger focus on quality improvement and patient care, using up-to-date data to drive better health outcomes and maintain NCQA compliance. www.smiledigitalhealth.com | sales@smiledigitalhealth.com | 877-537-3343Copyright © 2024 Smile CDR Inc. (doing business as Smile Digital Health). Slow Retrospective Process The process of developing and deploying quality measures for public reporting often takes years, delaying the availability of results to payers and providers resulting in retrospective review.Labor and Resource IntensiveTraditional quality measurement requires manual data entry, which is labor-intensive and prone to errors. This increases the likelihood of mistakes in interpreting and inputting information plus higher operational expenses.Fragmented Clinical KnowledgeTraditional HEDIS measures are often prescriptive, limiting adaptability, which makes evaluating specic populations accurately a challenge. Smile dQM: Fast, Compliant, and Scalable Healthcare Quality ReportingKey Features of the Smile dQM SolutionOut-of-the-box HEDIS Support PLUS non-HEDIS measure supportLicense available NCQA Digital Content Services HEDIS measures and support custom non-HEDIS custom quality measures with one dQM evaluation tool. Using open standards provides maximum exibility to evaluate measures across diverse populations.Intuitive, easy-to-use HEDIS evaluation toolReduce implementation overhead and manual data capture, let our CQI Engine do all the heavy lifting to analyze your data and evaluate your quality measures with the click of a button. Reduce errors and free up resources to focus on patient care.Evaluate large patient populations in real-timeImplement quality improvement at scale with results for 1 million patients with 250 FHIR resources in <1 hour with 100ms latency per patient per quality measure. Eciently generate data to improve population health management.Continuous care quality improvementSupport expanded use cases such as Care Gap Management and Clinical Decision Support with timely quality measurement data and continuous monitoring. Turn retrospective care delivery into prospective care management with earlier care intervention and better population health management.

Smile’s dQM Solution reduces the cycle to minutesClinician makes Adjustments at point of careScores submitted at desired levels to maximize revenue01 - IngestReceive FHIR® HL7 v2, or other health data tyres in Smile Health Data Platform (HDP)02 - EvaluateRun measure evaluations at scale for individual or group TIN03 - ReportAssess measure scores and build QPP or JSON reports based on your selected measures04 - SubmitSubmit QPP or JSON reports for each TIN to CMS API05 - UpdateRe-run reports and re-submit electronically with the click of a button.START TO FINISH OUR PROCESS IS MINUTES LONGGap in Care Automatically Flagged to Clinicianwww.smiledigitalhealth.com | sales@smiledigitalhealth.com | 877-537-3343Copyright © 2024 Smile CDR Inc. (doing business as Smile Digital Health). Smile dQM: Fast, Compliant, and Scalable Healthcare Quality ReportingThe Future is Fast with SmileThe Smile dQM HEDIS Solution simplies the process of evaluating and submitting these measures, oering an ecient and streamlined approach that helps organizations maintain compliance, enhance care, and increase protsContact us today to learn how you can lead the digital transformation of quality measurement.Take the Next Step in Quality MeasurementSmile dQM HEDIS Solution turns your clinical data into actionable insights using FHIR and CQL. Enhance care, reduce costs, and tailor quality reporting to meet your organization’s unique needs.01 - WaitFor hospitals to export patient data (this can take 2 days to 6 weeks)02 - CodeManually enter ICD-10 and CPT codes to identify encounters for evaluation03 - EvaluateAssess measure performance using a proprietary algorithm04 - SubmitUpload and submit quality measure report to CMS portal05 - UpdateManual process to update, re-calc, and re-submit reportsAdjustments to care made over 12 months - No visibility into eectivenessScores return lower than desired - Acting on data restrospctivelyTRADITIONAL dQM CYCLES ARE A YEAR LONGTraditional dQM Cycle is > 1 year

Common Features Across All APIswww.smiledigitalhealth.com | sales@smiledigitalhealth.com | 877-537-3343Copyright © 2025 Smile CDR Inc. (doing business as Smile Digital Health). *2022 CAQH Index Reports **AHIP study• Provides all functionality to both make bulk data requests,or respond to bulk datarequests from other payers• Support for Da Vinci Profiles and data filtering requirements• Advanced FHIR consent service• Proven successful Patient Access API • Support for new enhancedEOB resources and in process PriorAuth data• Advanced FHIR consent service• CDS Service for responding toprovider requests• Native Member AttributionSupport and Consent service• Advanced FHIR consentservice• Native support for ProviderDirectory requirements withthe Smile Health DataPlatform Smile CMS Suite Featurese-PriorAuth API workflows compliant with HL7 Da Vinci standardsHow We Can HelpSmile Digital Health offers acomprehensive and scalable solutionwith the CMS Suite, designed to propelyour data modernization efforts. Movebeyond compliance to reap the benefitsof a consolidated FHIR repository withcomputable data and the Smile ClinicalReasoning engine.Meeting CMS regulations is a fundamental requirement forMedicaid and Medicare payers, but achieving mere complianceisn’t enough to transform your business. To truly excel, payersmust streamline operations, integrate disparate systems, andunlock valuable insights from their data.The Smile CMS Suite empowers payers to transcend basic compliance. By facilitating integration with existing systems, it enhances data flow and management, while providing the tools to unlock new insights from semantically structured healthcare data.All APIs include mandate compliant auditing and reporting featuresas well as a system administration UI for transaction troubleshooting. Payer-2-Payer API Patient Access API• Coverage Requirements Discovery (CRD): Ensures that providers are aware of the coveragerequirements at the point of care, reducing delaysand enhancing patient satisfaction.• Document Template Rules (DTR): Supports the delivery of the correct templates to streamline documentation with support for pre-population to reduce the burden of data collection. • Prior Authorization Support (PAS): Facilitates the prior authorization process, reducing administrative burdens and delays, thereby improving efficiency and speed of care delivery. Provider Access API Provider Directory APIIt supports the provision of denial reasons asrequired by regulation, ensuring compliance andtransparency in the authorization process.• Advanced request routing engine to supportflexible rules based integration with any number of internal systems or external delegates andthird-party processors.• Take advantage of our industry-leading ClinicalReasoning Engine by authoring your medical policies into the CQL open standards computable data format to go beyond the mandates and fully automate your prior authorization process.Smile CMS Suite: Transform Complianceinto Efficiency

Operational EfficiencyStreamline operations with acentral FHIR repository to serveall API information requests. TheCMS Suite helps in automatingrepetitive tasks, allowing staff tofocus on more critical activities.Enhanced Decision-MakingAdvanced analytics providedeeper insights, enabling betterstrategic decisions. By leveragingconsolidated data, payers canidentify trends and makedata-driven decisionsthat improve patientoutcomes andoperational efficiency.Provider ProductivityBy reducing administrativeburdens and improving dataaccessibility, Payers can enhanceprovider relations and supportthe growth of their network.This enables providers tofocusmore on patient care,leading to betterpatient engagementand satisfaction.Comprehensive ComplianceFull compliance with CMS 0057Fregulations ensures that yourorganization stays ahead ofregulatory requirements,avoiding penalties andmaintaining goodstanding with CMS.www.smiledigitalhealth.com | sales@smiledigitalhealth.com | 877-537-3343Copyright © 2025 Smile CDR Inc. (doing business as Smile Digital Health). *2022 CAQH Index Reports **AHIP studyBy streamlining operations and reducing manual interventions, Smile CMS Suite helps youenhance operational efficiency, improve data integration, and make informed decisionswith advanced analytics.EFFICIENCY GAINSBy implementing the SmileCMS Suite, both Payers andclinical practices can reducetheir prior authorizationadministrative burden by upto 70%**. Auto adjudicationof Prior Auth requests candeliver approvals in realtime at the point of care.REAL-WORLD IMPACTCOST SAVINGSThe implementation ofthe Smile CMS Suite withAuto Adjudication can savePayers up to $3.30/memberin operational costs alone.*Key Benefits of the CMS SuiteContact us to discover how the Smile CMS Suitecan enhance your operational efficiency.Smile CMS Suite: Transform Complianceinto Efficiency

Solution Overview:Smile’s Payer-to-Payer solution addresses CMS-0057-Frequirements and complies with the Da Vinci Payer DataExchange (PDex) Implementation Guide (IG), providingseamless data exchange for payers on both the requestingand source side of the transaction:Consent and Privacy Leveraging OAuth 2.0 and SMART Backend ServicesAuthorization, Smile enables secure authorization,allowing members to share healthcare data withoutexposing sensitive information. For source payers,there is consent infrastructure for recording and www.smiledigitalhealth.com | sales@smiledigitalhealth.com | 877-537-3343Copyright © 2025 Smile CDR Inc. (doing business as Smile Digital Health). Performance, Scale and AccuracySmile’s solution can bulk ingest over 2 billion FHIRresources in under 26 hours, at a ground-breakingspeed of 255,000 transactions per second. It ispowered by features that protect confidential data Complete Interoperable ExchangeBuilt on FHIR and leveraging the Da Vinci PDex IG,Smile’s solution facilitates seamless data exchangeacross payer systems and scales to meet futurerequirements. The platform is designed to providepayers with flexibility in how they capture opt-in andconsent, whether as part of an enrollment process or through member portal applications. It manages authentication,member matching, and record retrieval, securely storing importeddata. The Payer-to-Payer API shares both native member recordsand those imported from other payers via a Bulk FHIR exchangeendpoint.from exposure to unverified third-party applications, while ensuringthat the right information is transferred to the right people at theright time.executing on member consent preferences. Smile ensures bothpayers work with the same member records using a member-matching operation with customizable rules.Effortlessly Secure and Compliant:Smile Digital Health’s Payer-to-Payer SolutionSmile’s Payer-to-Payersolution enablessecure, compliantdata exchange whileempowering membersto control their dataand simplifyingprocesses for yourorganization.Under the CMSInteroperability andPrior AuthorizationFinal Rule (CMS- payers must exchange five years ofclinical records, claims,and prior authorizationdata using a FHIR®-based API. Smile’sPayer-to-Payer solutionensures full complianceand delivers morebusiness value.0057-F),

Effortlessly Secure and Compliant:Smile Digital Health’s Payer-to-Payer SolutionWhat Sets Smile Apart:4. Data EnrichmentSmile links imported data to your existing sources,creating robust, searchable clinical histories. Thisenriched data is shared across CMS-mandated APIsto enhance care continuity and coordination withproviders. It can also be used in business specificanalytics to drive new insights. 2. Data Set ConformanceSmile’s solution integrates imported records into thenative FHIR patient record and shares them acrossAPIs, ensuring flexibility for internal applications. Itverifies that the right data is ingested in the correctformat and shared accurately, maintainingcompliance and reliability.3. Consent ManagementSmile’s solution ensures data shared via the Payer- to-Payer API conforms to Da Vinci PDex profiles. Itconfirms the correct data is ingested and sharedaccurately, delivering reliable, compliant exchanges.1. Compliance with CMS Payer-to-PayerRequirementsSmile’s solution ensures full compliance with CMSregulations, supporting the exchange of clinical data,claims, prior authorizations, and provenance records.It integrates with your FHIR system for seamless datasharing across CMS-mandated APIs.www.smiledigitalhealth.com | sales@smiledigitalhealth.com | 877-537-3343Copyright © 2025 Smile CDR Inc. (doing business as Smile Digital Health). Smile’s provencompliance ensuresyour organizationstays aligned with CMSregulations, while theplatform’s scalabilityallows you to managelarge volumes of dataefficiently. With industry-leading security, includingadvanced privacy andconsent tools, you cantrust that member datais protected. Smile’sAPI-driven flexibilitycaptures opt-in consentand executes the dataexchange processsmoothly, adaptingseamlessly to memberpreferences and regulatoryrequirements.Smile’s Payer-to-Payer solution is part of our comprehensiveCMS Suite, addressing all compliance needs.Empower your organization and optimize your dataexchange strategy with Smile, contact us to learn how. Why Choose Smile’sPayer-to-PayerSolution?

Think Beyond Compliance Surpass Your Growth Targets Use case Summary A large US pay vider payer provider implemented Smile s Health Data Platform HDP and achieved full compliance with the CMS 9115F Rule The 3 month long implementation also created foundations for the upcoming CMS0057 F Rule Due to the strategic nature of their initial investment the client is now positioned ahead of other payers in their ability to achieve new compliance requirements and build their data modernization strategy The Client A massive pay vider organization with a staff of over 200 000 personnel operating more than 30 hospitals and hundreds of clinics that serve millions across the United States Problems Faced The client required a solution that would make them compliant with the CMS 9115 F Rule Interoperability and Patient Access Final Rule while enabling flexibility to meet any subsequent regulations The challenge was integrating a scalable solution across their entire payerprovider network Their network served 12 5 million members and generated over 32TB of data annually which needed to be exchanged at high velocity Objectives The client required a compliant enterprise level solution without compromising security and without significant down time Their key objectives were A FHIR native backend that could ingest mega volume data a minimum of 1 6 billion claims from across different systems in a variety of formats Implementing on Azure Cloud so they could process as much as 64TB of data by 2025 which was double their 2021 volume Investing in a solution that built upon their data strategy and could be leveraged for other uses including meeting future regulations Procuring a solution from a vendor they could trust with proven large scale real world implementations To create a sustainable market share and new revenue streams in the CDS market The Solution The client procured Smile s Health Data Platform HDP to start them on their compliance journey Their entire network was fully adherent to the CMS9115 F Rule specifications within their 3 month requirement Based on the extensive experience from over 160 FHIR based enterprise level implementations and actively innovating with HAPI FHIR and Da Vinci IGs Implementation Guides Smile was able to provide the requisite architecture and upgradable data models to the client that met and surpassed their production requirements and satisfied their most optimistic growth targets The following features and capabilities of the HDP were key to them achieving all their objectives and future proofing their investment for upcoming mandates A FHIR native platform Smile s HDP is built upon the widely adopted open healthcare standard FHIR This gave the client an intrinsically compatible data exchange infrastructure with no vendor or proprietary system lock in A fully integrated implementation of the CMS9115 F solution across the client s entire network within 3 months smiledigitalhealth com sales smiledigitalhealth com 877 537 3343 Copyright 2024 Smile CDR Inc doing business as Smile Digital Health

Think ThinkBeyond BeyondCompliance Compliance Surpass SurpassYour YourGrowth GrowthTargets Targets On cloud The HDP is designed to run wherever data is stored on premises on cloud across multiple cloud platforms or a hybrid setup The client s hybrid setup was reconfigured to Azure Cloud as per their direction Performance The HDP proved its processing capability of 1 6 billion claims across the client s network as per their requirement Since then the processing power of Smile s HDP has grown to a ground breaking 255 087 transactions per second returning search queries across the network in under 1 000 milli seconds Timely Implementation Rapid tooling and modular architecture implementations allow for a high level of customizability without heavy allocation of the client s in house IT teams This lowered the client s deployment time resources and costs The completely integrated CMS9115 F solution was implemented in under 3 months The Drummond Group Certification This voluntary certification is a rigorous program that tests a solution s real world interoperability and compliance adherence The certification proves that inherent sophisticated interoperability is built into the backend of Smile solutions The client appreciated that Smile was the first company to achieve the Drummond Group Certification Continued Benefits of Implementing Smile s HDP Since Smile s HDP is more than a siloed regulatory and compliance solution the client was able to leverage it to streamline their business operations and save on costs Built upon Smile s FHIR native HDP the client developed a single API to manage security and risk across all internal applications thirdparty vendors and partners with less ongoing maintenance This implementation freed up inhouse technical and operational teams to focus on addressing their business objectives Since the initial implementation in 2021 Smile has continued to innovate beyond the client s original needs The client now leverages the HDP s expanding capabilities including unlimited scalability with the new MegaScale feature and enhanced performance This ensures secure connected and limitless growth across their systems beyond their goal of being able to process 64TB of data by 2025 When the CMS 0057 F Interoperability and Prior Authorization Final Rule was announced in January 2024 the client was positioned to upgrade certain modules that were part of Smile s original implementation of CMS 9115 F The upgrades required minimal interruptions to their business workflows As a result the client s data and IT architecture has all the necessary foundations and integrated workflows already configured for the CMS 0057 F Rule smiledigitalhealth com sales smiledigitalhealth com 877 537 3343 Copyright 2024 Smile CDR Inc doing business as Smile Digital Health

Think Beyond Compliance Surpass Your Growth Targets Strategic Value There is value in going beyond the check thebox mentality when it comes to complying with CMS regulations Payers and Pay viders who want to realize value based care outcomes utilizing Smile s technology solutions can leverage Automated ePriorAuth Claim Processing and Cycle Time Smile s ePA solution is compliant with CMS 0057 F and can increase the speed appropriateness and effectiveness of care Beyond the regulations the solution delivers real time data exchange provision of transparency and coverage requirements and automated PA responses Truly Interoperable Data Fabric Smile s solutions create a single unified FHIR record which promotes a 360 degree view of patient member records across the network Synchronizing data across all systems EHRs labs pharmacies insurance etc eliminates information silos reduces administrative burden and improves risk management An evolving truly interoperable data fabric leads to better patient member care Automated Clinical Reasoning Smile s Clinical Reasoning engine powered by FHIR and HL7 s Clinical Quality Language CQL delivers automated adjudications of prior authorization requests proactive care gaps analysis and real time digital quality measures like HEDIS and MIPS measures Smile Digital Health and CMS Compliance In 2021 Smile successfully implemented CMS 9115 F requirements for over payers supporting over 100 million US lives Our payer clients chose us as the 1 vendor of choice Today Smile s CMS Suite continues to deliver comprehensive compliance with the CMS 0057 F mandate Whether you need an out of the box product some basic API integrations to fit within your existing tech stack or you want to go beyond compliance and proactively position your business ahead of the market Smile has you covered smiledigitalhealth com sales smiledigitalhealth com 877 537 3343 Copyright 2024 Smile CDR Inc doing business as Smile Digital Health

Executive SummaryThe client: A large US insurance provider (payer) with over 350 operating clinics and care centers, and several subsidiary companies across the US servicing over 17 million members. The client’s network includes several lines of business, each with their own suite of IT systems, data sources, policies and EMR systems. The issues:The client’s network includes sources and formats of data from hundreds of points-of-care systems, several legacy EMRs and multiple third-party vendors. The network’s IT infrastructure included pools of unstructured data sets, disjointed data exchange engines and incompatible security and policy features, which led to cumbersome and even inaccessible health information ow. The client experienced continued performance and downtime issues with their data services cloud vendor—which processed only ~50,000 transactions per second—which severely limited data exchange across the network. TThis caused restrictions on their scalability initiatives, which required manual interventions—allocating time, budget and resources for frequent infrastructural, upgrade and data management projects. Keeping in step with industry expansion trends, the client’s future objectives included new acquisitions and business consolidation. They recognized they could not scale and stay compliant with ONC and CMS mandates with their existing restrictive, manual, costly data exchange architecture.The objective:The client approached Smile Digital Health to demonstrate the functional capabilities of our solution suite. Their evaluation objectives included: • Mega volume, high speed data ingestion—at least 200,000 transactions per second today with the ability to scale beyond that in the future • Standardization of data from their multiple point of care systems in a variety of formats—HL7 v2, HL7 v3, C-CDA, CSV and JSON—into the interoperable open FHIR® format (i.e. no proprietary vendor lock-in models)• Systematic, streamlined and automated information ow and processes on an event-based data architecture that can scale across the network and require minimal manual intervention• IT infrastructure maintenance and updates with no down-time• Shared security, auditability and encryption features• Data exchange management in compliance with CMS 9115-F Patient Access API and Provider Directory API.To avoid delays and interruptions to their business operations the client required a short implementation period with minimal downtime. smiledigitalhealth.com | sales@smiledigitalhealth.com | 877-537-3343Copyright © 2024 Smile CDR Inc. (doing business as Smile Digital Health).Payer Data Modernization: Mega-Volume Ingestion in 5 Weeks

Solution & Expertise Solution: Smile’s Health Data Platform (HDP) is a modular, highly congurable, robust data exchange and interoperability platform. It creates a data ingestion engine and repository that seamlessly integrates large volumes of unstandardized legacy data from hundreds of disconnected sources across state jurisdictions. Data is standardized into the FHIR format regardless of which EMR or external third-party systems it originated in. Expertise: Based on the extensive experience from over 160 FHIR-based enterprise-level implementations, and actively innovating with HAPI FHIR and IGs (Implementation Guides), the team at Smile designed and implemented several architectural and data ow strategies that met all of the clients objectives. The platform’s ingestion engine and the innovative solution architecture enabled the production time for Smile’s implementation of ~5 weeks—from the date of contract to the go-live day, including the evolutionary phases of architecture design. Time-to-Production Benchmarks Achieved Solution:Smile’s Health Data Platform (HDP) is a modular, Smile HDP’s exceptionally short production time—~5 weeks—was made possible by two main components:Designing and Implementing a Streamlined and Secure ArchitectureThe architecture design included automations and real-time data processing to create, modify and query data across systems. This unied the disparate workows and increased data access speed across the network. The overall throughput (system performance speed measured) was 255,087 interactions per second, with concurrent transactions—like search queries through databases across the network—returning in under 1,000 milli-seconds. Smile’s solution includes built-in security by design—highly congurable encryption features like the KeyStore Protocol and Mutual Authentication, and certications like HITRUST R2 v9.4, ISO 27001:2013, ISO 27018:2019, ISO 13485:2016, and SOC-2 Type II. This allowed every interaction across the network—access requests, queries, log-ins and more—to be sequentially recorded into an immutable log, available for audit. When this secure and streamlined architecture was installed, the client achieved a 99.99% annual availability (under 52.5 minutes of network downtime in a year). smiledigitalhealth.com | sales@smiledigitalhealth.com | 877-537-3343Copyright © 2024 Smile CDR Inc. (doing business as Smile Digital Health).Payer Data Modernization: Mega-Volume Ingestion in 5 Weeks

Large-scale High-Speed Data IngestionThe Smile HDP ingested and housed data for over 2 million patients, with over 2 billion resources in the FHIR format. The ingestion and conversion process to load these 2 billion resources to FHIR took just over 26 hours, compared to the industry average of ~5 days. These resources were standardized in FHIR, de-duplicated and made actionable. Smile’s cloud repository that housed these resources consumed ~2.5 TB of storage, which is less than half of its capacity. With these main components implemented, the client could now scale without compromising performance and security. In addition, their in-house teams could continue technical maintenance, optimization upgrades and additions to the network without signicant cost, eort and time.Strategic ValueBuilt on the open FHIR standard, Smile’s no vendor lock-in commercial implementation ensures that data ownership remains with the client. With standardized and connected data sources across their network, the client’s data now supports real-time clinical and business decision-making. As well, having a ubiquitous data source in the Smile HDP sets the client up for successful deployment of future AI/ML solutions.Since Smile Digital Health is certied in the Drummond Group Payer and Patient Access FHIR API, all network interactions can be accessed, ltered and routed in adherence to the interoperability and data exchange mandates outlined in the CMS 9115-F Rule. Smile’s built-in compliance readiness further creates the foundation for the client to: - adhere to upcoming ONC and CMS mandates including CMS 0057-F, and - upgrade to Prior Authorization and Payer to Payer solutions to realize operational eciencies and capture market advantage.smiledigitalhealth.com | sales@smiledigitalhealth.com | 877-537-3343Copyright © 2024 Smile CDR Inc. (doing business as Smile Digital Health).Payer Data Modernization: Mega-Volume Ingestion in 5 Weeks Bring network-wide payer data modernization to your organization. Book a discovery meeting with us today!CLICK HERE

Future proofed Payer Beyond the CMS Mandates Compliance Strategy that ASupport PayerValue based Strategy Care Summary A leading US insurance payer is using their rapid achievement of compliance with CMS 9115 F to fast track and accelerate beyond CMS 0057 F mandates With their digital transformation built upon Smile s FHIR native Health Data Platform they are strategically positioned for operational efficiency increased ROI and value based care initiatives The Client The client is one of the US s leading health insurance payers and benefits providers They service over 5 million members across 13 states with over 25 lines of business The Challenge With no in house access to the requisite technical resources the client had to be fully compliant with the CMS 9115 F Patient Access Final Rule by July 1st 2021 in order to avoid fines By March 2021 they had not yet chosen a compliance vendor and were managing competing large scale internal projects at the time including attempting to consolidate their disparate data sources The Objectives The CMS 9115 F Rule was highly disruptive for the client as it was for many payers who had to quickly maneuver and address the compliance requirements Their objectives were A To be fully compliant before the enforcement date of July 1st 2021 B Minimal disruption to their ongoing internal projects priorities and timelines C Accelerating their cloud strategy D Maintaining complete ownership and access to their data E Rapidly learning and adopting FHIR healthcare s leading global interoperability open standard for data exchange F Consolidating and transforming their fragmented and unstandardized data to FHIR The Solution The client engaged with Smile Digital Health in April 2021 With a combination of our expertise with compliance implementation for Payers and our out of the box suite of solutions their requirements were exceeded Smile s Health Data Platform is now the client s comprehensive FHIRnative data repository Upon this platform a precursor of the CMS Suite was built giving the client full compliance with the CMS 9115 F Rule within 3 months of signing the contract They were compliant well before the enforcement date and all their objectives were satisfied In addition the client also achieved Increased member engagement with clients accessing their claims and clinical data through the new FHIR APIs Preemptive completion of the Payer to Payer module not required as part of the finalized CMS 9115 F Rule but a requirement of the upcoming CMS 0057 F Rule Early preparedness for the CMS 0057 F Rule having completed the work of integrating all their disparate data sources into FHIR with strategic architectures completed to ensure future ready compliance Burden reduction within their Quality Teams with higher accessibility of FHIR data from all formats paper and digital The ability to run continuous HEDIS measures in real time throughout the year with their FHIR data models smiledigitalhealth com sales smiledigitalhealth com 877 537 3343 Copyright 2024 Smile CDR Inc doing business as Smile Digital Health

Future proofed Payer Beyond the CMS Mandates Compliance Strategy that ASupport PayerValue based Strategy Care The mechanisms to scale their HEDIS measures to several of their 25 lines ofbusiness thereby reducing the overall cost of care and enhancing their reimbursement potentials Smile Digital Health continues to provide onpremise support to the client on their cloud including all configurations and ongoing maintenance Advantages of Smile s Platform and Compliance Solutions Meeting mandates like CMS 9115 F and the upcoming CMS 0057 F are regulatory requirements that all payers have to meet to avoid penalties However strategically implementing compliance solutions that support value based care unlocks significant long term ROI For our client and other innovative payers compliance was only the first step they quickly recognized the broader benefits that transformed their operational efficiency and business capabilities Designed for Re usability Smile s Health Data Platform is extendable allowing initial implementations to support future ones with minimal additional effort This capability enabled our client to achieve CMS 9115 F compliance while also laying the groundwork for CMS 0057 F and use cases like HEDIS quality measures Each additional use case becomes easier and more cost effective to implement building cumulative value across the organization Streamlined Operations The Health Data Platform leverages FHIR based APIs to offer complete compliance without compromising risk security and performance Our customizable platform can enable access through consent controls thereby reducing risk and enhancing security even when third party apps are involved These streamlined operations simplify data sharing and contribute to a smoother more efficient ecosystem Future proofed Toolkit of Capabilities The Health Data Platform includes a range of tools such as Master Data Management FHIR Gateway SMART on FHIR integrations and a FHIR CQL engine that equip the client for evolving needs These capabilities facilitate the validation of digital quality measures continuous quality analytics automate prior authorization processes enable real time analysis of care gaps and enhance risk adjustment accuracy smiledigitalhealth com sales smiledigitalhealth com 877 537 3343 Copyright 2024 Smile CDR Inc doing business as Smile Digital Health

Future proofed Payer Beyond the CMS Mandates Compliance Strategy that ASupport PayerValue based Strategy Care Conclusion With a secure and scalable FHIR based platform already in place our client is primed to leverage their investment across network wide business and compliance needs Each successive use case builds on their initial implementation adding substantial value without requiring redundant effort or costs Smile s CMS Suite further streamlines the API framework needed for the upcoming mandates keeping the client agile and fully prepared for future regulatory changes The US healthcare system is moving towards a value based care system that directly ties payer reimbursements to the delivery of measurable high quality clinical data Our client s early investment in a comprehensive quality focused data platform positions them to capture significant cost savings optimize care delivery and maximize reimbursements By moving beyond compliance and embracing digital transformation they are not only fulfilling regulatory requirements but also establishing a foundation for long term success and a competitive edge in a rapidly evolving industry smiledigitalhealth com sales smiledigitalhealth com 877 537 3343 Copyright 2024 Smile CDR Inc doing business as Smile Digital Health

Smile Digital Health622 College Street, Suite 401Toronto, Ontario M6G 1B4, Canada info@smiledigitalhealth.com1 (877) 537-3343www.SmileDigitalHealth.comCopyright © 2024 Smile CDR Inc. (doing business as Smile Digital Health).All product names, logos, and brands are the property of their respective owners. All company, product and service names used are for identication purposes only. The use of these names, logos, and brands does not imply endorsement.TM