CMS and the ONC have proposed a new rule that would require payers regulated by CMS to adopt open-industry standards to advance interoperability.
The proposed rule, which aims to advance health information exchange interoperability and streamline prior authorization processes, would require payers to:
- Establish application programming interfaces so that they can share information with healthcare providers about patients covered under their plans.
- Share information with other payers when and if patients change plans.
- Allow providers to obtain coverage requirements for items and services that require prior authorization.
- Submit information needed to request the authorization.
The rule builds off of CMS' Advancing Interoperability and Improving Prior Authorization Processes proposed rule, according to a Feb. 27 blog post from the ONC.