CMS Final Rule and ePrior Authorization: What Providers and Payers Need to Know
Preparing providers and payers for interoperability mandates - Healthcare Finance
A consultant specializing in FHIR Solutions provided insights regarding the preparation of providers and payers for upcoming interoperability mandates.
Summary
Scott Rossignol et al. will discuss the Centers for Medicare and Medicaid Services (CMS) final rule regarding interoperability and prior authorization at HIMSS 2026. The focus is on how payers and providers must transform data exchange and electronic decision-making processes.
Key Players
Details
Scott Rossignol, a consultant from FHIR Solutions, warns that many providers and payers are unprepared for the CMS's final rule on interoperability and prior authorization, which takes effect in January 2027. This rule (CMS-0057) targets payers like Medicare Advantage and Medicaid, mandating the implementation of key APIs—including Prior Authorization API, Provider Access API, and Patient Access API—to improve data exchange. Rossignol emphasizes that an API is needed for providers to submit and receive electronic decisions directly within their EHR or practice management systems. The session will cover not only the technical details but also pilot examples from initiatives like the HL7 Da Vinci Project, which aims to accelerate the adoption of HL7 FHIR standards for better data exchange between payers and providers. This highlights the necessity of establishing processes for how providers transmit data and how payers respond to it.
Technology Note
FHIR（Fast Healthcare Interoperability Resources）は医療データ交換の国際標準。このエントリの関連技術: FHIR
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