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CMS' Interoperability and Prior Auth rule will require health plans to transform prior auth processes and invest in technology. Plans need to begin this change to ensure they are in compliance by 2027. #CMSInteroperability #priorauthorization #healthplan

> Understanding Electronic Prior Authorization The CMS Rule CMS-0057-F mandates that, by January 1, 2027, all CMS-regulated payors must implement electronic Prior Authorization APIs. This advancement is poised to revolutionize healthcare administration, projected to save CMS an impressive $15 billion over the next decade (https://lnkd.in/gai8pJAt). The ripple effect of this mandate is expected to encourage other payors to adopt similar technologies, paving the way for substantial savings for both providers and payors. More importantly, it promises to enhance patient care and alleviate the common frustration faced by both physicians and patients. Electronic Prior Authorization simplifies the approval process: healthcare providers can submit authorization requests digitally, payors can efficiently request necessary patient information from electronic records, and responses—approvals or rejections—are communicated electronically. This not only accelerates the process, enabling authorizations to be completed in minutes rather than days, but also involves patients directly through consumer apps connected to the Patient Access API. This system represents a significant step forward in patient care and operational efficiency, benefiting providers, payors, and patients alike—a true win-win-win scenario. Below is a straightforward diagram illustrating the workflow of Electronic Prior Authorization. It highlights that while we can leverage much of our existing healthcare infrastructure, there are new components, marked with dotted lines, essential for facilitating this digital transformation. Electronic Prior Auth is implemented using the FHIR (https://hl7.org/fhir/) and CQL(https://cql.hl7.org/) standards in healthcare. CQL is the same standard used by HEDIS measures. Using existing standards will help electronic prior auth be adopted faster in healthcare. If you want a more detailed guide, you can see: https://lnkd.in/gEXX6Egs #priorauth #healthcare #cms

🌐 The U.S. healthcare system is evolving, and the CMS Interoperability and Prior Authorization Final Rule is at the forefront of this transformation. In our latest insight, we dive into the challenges and opportunities this rule presents for payers, from API implementation to enhanced data sharing and streamlined prior authorizations. Read the full article and stay ahead of the curve! 📖 https://hubs.ly/Q02Y7Nh30 #HealthcareInnovation #PatientCare #AArete

#PriceTransparency is emerging as a driving force behind patient satisfaction and regulatory compliance. Explore how #healthcare organizations are adapting to this new reality and find out how #SEI can guide your journey toward compliance and success.

#PriceTransparency is emerging as a driving force behind patient satisfaction and regulatory compliance. Explore how #healthcare organizations are adapting to this new reality and find out how #SEI can guide your journey toward compliance and success.

#PriceTransparency is emerging as a driving force behind patient satisfaction and regulatory compliance. Explore how #healthcare organizations are adapting to this new reality and find out how #SEI can guide your journey toward compliance and success.

#PriceTransparency is emerging as a driving force behind patient satisfaction and regulatory compliance. Explore how #healthcare organizations are adapting to this new reality and find out how #SEI can guide your journey toward compliance and success.

#PriceTransparency is emerging as a driving force behind patient satisfaction and regulatory compliance. Explore how #healthcare organizations are adapting to this new reality and find out how #SEI can guide your journey toward compliance and success.

#PriceTransparency is emerging as a driving force behind patient satisfaction and regulatory compliance. Explore how #healthcare organizations are adapting to this new reality and find out how #SEI can guide your journey toward compliance and success.