Knowledge Center

With the currently proposed CMS rule, 0057-P, Advancing Interoperability and Improving Prior Authorization Processes, improving this process has become a hot topic. Yet, looking across the industry, there are still many bespoke solutions that don’t solve for the scalability problem. Although X12 278 didn’t get much traction, at least it offered a standardized way for payer and providers to interact.

The HL7 DaVinci project has offered a FHIR-based alternative that uses new standards, is scalable, and takes workflow into consideration. Learn more about a scalable approach to prior auth and how we need to start to build the tools in our toolboxes to be ready for it.