Phase 1: Enactment & build · Step 1.3

Build the claims, payment & data systems

Months 0–18, then continuous · UHA Chief Information Officer; MACs; U.S. Digital ServiceDiscuss this step

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Task 1.3.4 of 8

Build a real-time eligibility API so any provider can check coverage in under 1 second (replacing 270/271 transactions with hundreds of payers).

Who does it

USDS / UHA

When

Month 3–12

Trade-off

A real-time eligibility API removes front-desk verification but creates a single point of failure for every check-in in the country.

Part of: Build the claims, payment & data systems

Scale Medicare's existing fee-for-service claims infrastructure from about 1.3 billion to about 5 billion claims a year, add hospital global-budget payments, dental and vision claim types, and a national real-time eligibility check.

This step changes 2 existing laws, programs, or institutions. See the list.