01
CMS file pipeline
Versioned loading and reconciliation of claims and assignment files.
Healthcare / ACO Software
ACO software built around the Shared Savings Program rules
A Medicare ACO runs on CMS files: assignment lists, claims and participant lists that change every quarter, plus notices beneficiaries must receive. Agnotic Technologies builds ACO software that loads and reconciles those files, tracks beneficiary notices and data sharing choices, checks SNF 3-day waiver eligibility and shows each participant its own performance.
CMS files
Loaded and reconciled each cycle
Opt-outs
Enforced in every view
SNF waiver
Checked at referral
Trusted by global innovators
Industry Overview
What is ACO software?
ACO software is the operational system a Medicare accountable care organization uses to load CMS assignment and claims files, manage its participant list, track beneficiary notices and data sharing opt-outs, check SNF 3-day rule waiver eligibility and assemble quality reporting data. Agnotic Technologies builds it around the Shared Savings Program rules in 42 CFR Part 425.
Industry Challenges
Where do ACO operations break?
The gaps we look for first, because each one is a program requirement, not a nice-to-have.
A new assignment list arrives, but the old one is still loaded in the care management tool, so outreach targets last quarter's beneficiaries.
A beneficiary declined data sharing, yet their claims still show in a participant's export.
Written notices were sent, but nobody tracked the follow-up communication or kept the record of how it was made.
A SNF admission without a 3-day stay is approved before anyone checks the beneficiary's assignment and the SNF's affiliate agreement.
A practice leaves the ACO, and the participant list and CMS notice are updated weeks later.
Missing substance use disorder claims are read by analytics as no care at all.
Our Approach
How should an ACO approach the build?
Three decisions we make with your ACO operations and compliance leads.
Version every CMS file
Each assignment list and claims delivery is loaded as a version, and every view says which version it uses.
Put opt-outs in the data layer
Data sharing choices are enforced where data is read, so no report, export or app can show claims the beneficiary declined to share.
Check eligibility where the decision happens
The SNF waiver check runs at the point of referral, using the current assignment list and the affiliate agreement on file.
Capabilities
What do we build into ACO software?
Operations modules for Shared Savings Program ACOs. Quality measure engines and risk adjustment stay in your value-based care stack.
CMS file ingest and reconciliation
Claim and Claim Line Feed files and assignment reports loaded, checked and compared with the previous version.
Participant and provider list
TINs and NPIs with change requests, certification and termination tracking.
Beneficiary notice tracking
Signage, written notices and follow-up communications tracked per participant and beneficiary.
Data sharing opt-out enforcement
Opt-out flags from CMS files applied to every query, export and app.
SNF waiver eligibility check
Assignment, model and affiliate checks at referral, with the result stored.
Quality reporting data assembly
Extracts from participant EHRs assembled for the quality data CMS asks for.
Participant performance views
Each practice sees its own assigned beneficiaries, spending trends and open tasks.
Audit records
Records of notices, checks and list changes kept for CMS on request.
How It Works
How does a quarter of ACO data flow?
The cycle we build for each CMS delivery, from download to participant views.
Receive the delivery
Claims and assignment files are downloaded and stored as a new version.
01
1
Validate and reconcile
Record counts, beneficiaries added and removed, and file errors are checked against the last version.
02
2
Apply opt-outs
Data sharing flags are applied before any data reaches reports or apps.
03
3
Refresh participant views
Each participant's beneficiaries and performance views are rebuilt from the new version.
04
4
Update notice tasks
Newly assigned beneficiaries get notice and follow-up tasks for their participant.
05
5
Feed downstream tools
Care management and analytics tools receive the new version through an agreed interface.
06
6
Engineering Stack
Systems and standards behind ACO software
Chosen to fit your participants' EHRs and your analytics stack. We build in your cloud account.
Data
Versioned CMS file storeBeneficiary and participant modelOpt-out enforcement in the data layer
Clinical data
HL7 FHIR R4 and bulk data from participant EHRsHL7 v2 ADT for admission eventsQRDA and EHR extracts for quality data
Applications
Participant portalNotice and task trackingSNF referral check
Security
Role-based access by participantAudit loggingEncryption in transit and at restBusiness associate agreement before PHI
Rule to feature
Which Part 425 rule does each feature support?
The table we fill with your ACO compliance lead. Each feature keeps the record that shows the rule was followed.
| Part 425 requirement | Software feature | Record that proves it |
|---|---|---|
| Beneficiary notification, 425.312(a) | Signage and notice tracker per participant site; written notice queue for assigned beneficiaries | Notice date, method and site per beneficiary |
| Follow-up communication, 425.312(a)(2)(v) | Follow-up task due within 180 days of the written notice | Follow-up date and how it was made available |
| Decline claims data sharing, 425.708 | Opt-out flag from CMS files suppresses identifiable claims in every view and export | Date the flag arrived and the suppression log |
| Substance use disorder claims, 425.708(c) | Analytics flag gaps instead of treating missing claims as no care | Rule version applied to each report |
| SNF 3-day rule waiver, 425.612 | Eligibility check at SNF referral: assignment, two-sided model and affiliate agreement | Check result, list version used and agreement on file |
| Participant list, 425.118 | TIN and NPI list with change requests and a 30-day termination notice task | List versions, certifications and change history |
Measured Impact
What should ACO leaders be able to see?
Views we build with your ACO operations and medical leadership.
Assignment
Changes per delivery
Beneficiaries added and removed, by participant.
Notices
Notices and follow-ups
Written notices sent and follow-ups due or late.
SNF
Waiver use
Waiver admissions by SNF affiliate, with check results.
Participants
Practice performance
Spending trends and open tasks for each participant.
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Use Cases
Where do ACOs start?
First releases we scope, each one tied to a program requirement.
02
Notice and follow-up tracking
Notices and follow-ups recorded per participant and beneficiary.
03
SNF waiver check
Referral-time eligibility check for SNF affiliates.
04
Participant portal
Practice-level views of assigned beneficiaries and tasks.
05
Participant list management
TIN and NPI changes, certifications and termination notices.
06
New ACO setup
Operations tooling for an ACO entering its first agreement period.
Integrations
Which systems does ACO software connect to?
The systems an ACO operations platform reads from or writes to, agreed during scoping.
Claims and assignment
CMS data files
Clinical data
Participant EHRs (Epic, Oracle Health (Cerner), athenahealth and others)
Outreach
Care management platform
Measures
Analytics and quality tools
Referrals
SNF affiliates
Admission events
Health information exchange
Compliance-First Development Services Backed by Global Standards
We build secure, scalable products designed for privacy, interoperability, and regulatory readiness from day one across every sector we serve.
Health Insurance Portability and Accountability Act
Protect PHI with privacy-first architecture, encrypted storage and transmission, and strict access controls.
Fast Healthcare Interoperability Resources
Enabling standardized health data exchange through standards-based API mappings.
Health Level Seven International
Supporting enterprise-grade interoperability for clinical messaging and record workflows.
Our Edge
Why Global Leaders Choose Us
We combine deep technical expertise with industry-specific knowledge to deliver solutions that aren't just functional, but transformational.
Enterprise-Grade Security
We implement rigorous security protocols and compliance standards (HIPAA, GDPR, SOC2) across all industrial solutions to protect sensitive data.
High-Performance Scaling
Our architectures are built to handle massive data loads and user bases, keeping performance steady whether you're serving ten or ten million.
Accelerated Time-to-Market
Using our suite of internal tools and proven frameworks, we cut setup work so your first release reaches users sooner.
Embedded AI Integration
Beyond simple wrappers, we build deep-learning integrations and predictive analytics directly into the core of your industry-specific workflows.
Engagement Model
How does an ACO software engagement work?
The CMS file pipeline is the usual first requirement. We agree its boundaries and a delivery date with your operations lead.
01
Scoping call
We review your participants, current tools, CMS file handling and the first requirement.
02
Rule mapping
Your compliance lead fills the rule-to-feature table with us.
03
Fixed-scope first release
One requirement end to end, with opt-out enforcement and audit records in place.
04
Participant rollout
Practices are onboarded with their own access and views.
05
Scale and support
More requirements, integrations and file changes as CMS updates them.
Facts and sources
Which Part 425 rules shape ACO software?
Short facts we design the features and records around, each linked to its primary source.
A Shared Savings Program ACO must make sure beneficiaries are told that its participants take part in the program and that they can decline claims data sharing, through signs in participant facilities, written notices on request and a standardized written notice to assigned beneficiaries.
Source: 42 CFR 425.312(a) (eCFR)After the standardized written notice, the ACO or participant must follow up with the beneficiary verbally or in writing no later than 180 days later, and keep a record of each follow-up and how it was made available.
Source: 42 CFR 425.312(a)(2)(v) (eCFR)A beneficiary's request to decline claims data sharing stays in effect until the beneficiary contacts CMS to change it, and CMS does not share identifiable claims about substance use disorder diagnosis and treatment without the beneficiary's explicit written consent.
Source: 42 CFR 425.708 (eCFR)CMS waives the 3-day inpatient stay requirement before covered SNF care for eligible beneficiaries assigned to ACOs in a two-sided model, when the care is furnished by an eligible SNF that has a written affiliate agreement with the ACO.
Source: 42 CFR 425.612(a)(1) (eCFR)An ACO must maintain and submit an accurate list of each ACO participant with its Medicare-enrolled TIN and each ACO provider or supplier with its NPI, and notify CMS no later than 30 days after a participant agreement ends.
Source: 42 CFR 425.118 (eCFR)
Voice of success
We don't just build products; we forge lasting partnerships. See how we've helped industry leaders transform their vision into technical reality.
“I can clearly see how Agnotic has a unique way of handling end-to-end development. They are always active on quick chat and provide support quickly.”
Aaron Phelan
Founder, Benchmark
“Agnotic combines deep technical expertise with strong domain knowledge. They understand the business context, anticipate challenges, and make collaboration smooth and effective.”
John Pasmore
Founder, Latimer
“Agnotic is the best technical team we evaluated. Their engineering excellence made our work dramatically easier and allowed us to stay focused on what matters most for maternal care outcomes. They took full ownership of the technical execution, and we are always happy to continue working together.”
Kim Smith
Founder, My Lauren
Related services
Related value-based care services
This page covers ACO operations under Part 425. These pages cover the analytics and care programs around it.
Value-based care software
Attribution, quality measures and contract performance.
Population health software
Risk stratification and care gaps across a population.
Care management software
Care plans and outreach for high-risk patients.
Care coordination software
Referrals and transitions between care settings.
HIPAA requirements for software teams
The safeguards we build into every system that holds patient data.
MSO software development
Shared systems for management services organizations that run physician groups.
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Cross-Industry Reach
The Same Engineering Patterns, Across Other Industries
The technical patterns behind this platform translate naturally into adjacent verticals.
Frequently Asked Questions
No. Quality measure engines, attribution analytics and care gap logic belong to your value-based care stack. ACO software handles the Shared Savings Program operations around it: CMS files, notices, opt-outs, the SNF waiver and the participant list.
No. Risk adjustment stays in your analytics tools. The ACO platform feeds them versioned, opt-out filtered data, so every score is built on the right beneficiaries.
The opt-out flag from CMS files is enforced in the data layer. Identifiable claims for that beneficiary are suppressed in every view, export and app, and the suppression is logged.
The file handling and notice tracking patterns carry over, but REACH rules come from the model's participation agreement rather than Part 425. We map them from your agreement, not from this page's table.
The number of participants and their EHRs, which requirements are in the first release, how CMS files are delivered today and the downstream tools to feed. We give an estimate after the rule mapping, when the first requirement is clear.
The CMS file pipeline with opt-out enforcement is the usual first release, and its date depends on how files are handled today and which tools it must feed.
Industries