The CMS’ Advancing Interoperability and Improving Prior Authorization proposed rule

The Centers for Medicare and Medicaid Services (CMS) has proposed new rules to enhance healthcare interoperability and streamline prior authorization. The regulations aim to:

• Improve data sharing via FHIR APIs, allowing access to prior authorization info
• Mandate timely documentation on prior authorization decisions
• Establish a standard FHIR Payer-to-Payer Data Exchange for better health record portability
• Introduce electronic prior authorization measures for CMS program participants

These changes will impact payers and providers. Technical and policy professionals should engage leadership to ensure compliance. Read the full white paper to prepare for CMS' proposed rule.