CMS, ONC propose new rules for payer data standards

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.

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