New CMS interoperability rule would streamline prior authorization processes

The proposed rule aims to enhance patient access and smooth API-enabled data exchange by requiring the use of specific HL7 FHIR implementation guides by payers. The U.S. Centers for Medicare and Medicaid Services issued a proposed rule Thursday aimed at improving the electronic exchange of healthcare data among payers, providers and patients.

The rule would require Medicaid, CHIP and QHP programs to build HL7 FHIR-based APIs to support data exchange and prior authorization. It also includes a proposed API standard for healthcare operations nationwide.

“For patients, there will be no more wrangling with prior providers and locating ancient fax machines to take possession of one’s own data; for providers, there will be no more piecing together patient health histories based on incomplete, half-forgotten snippets of information pried out of the patients themselves; for payers, this is the first step towards building the important data sharing systems we need to move towards value,” wrote CMS Administrator Seema Verma in a blog post accompanying the announcement.