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Prior Authorization Takes a Leap Forward in CMS Regulation

Healthcare IT Today

I talked to Nikki Henck, Senior Director of Utilization Management at Sagility , about the implementation and potential impact of this proposed requirement, which, if finalized, will be enacted in January 2026. The release of FHIR in the mid-2010 decade changed everything. These factors are incentives for adoption.

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CMS prior authorization rule finally crosses the finish line

Redox

More time to comply with API requirements The finalized rule requires that both payers and providers update or implement a variety of HL7® Fast Healthcare Interoperability Resources (FHIR®) APIs. In other words, Prior Authorization APIs will be compliant if they use FHIR and X12, or purely FHIR. X12 to FHIR) or small (e.g.

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Finding the future of interoperability with Redox: Part 1 – Bulk FHIR

Redox

Up first: Using bulk FHIR. What is bulk FHIR? Like many aspects of HL7 ® Fast Healthcare Interoperability Resources (FHIR ® ), there has been a lot of hype about the potential of using bulk FHIR to get large amounts of data out of EHRs. That’s where bulk FHIR comes in.

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California says goodbye to fax machines. Hello to DxF.

Redox

Small physician practices, rehabilitation hospitals, long-term acute care hospitals, acute psychiatric hospitals, small rural acute care hospitals, and nonprofit clinics will have until January 2026. Of note, the XCPD, XCA, and XDR profiles do not currently support FHIR natively.

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Healthcare Analytics and Interoperability – 2023 Health IT Predictions

Healthcare IT Today

The CMS proposed ruling requires impacted payers to build and maintain a FHIR API, starting January 1st, 2026, in effort to improve the cumbersome and costly prior authorization process. This will further endeavor to cement FHIR as the data standard to support future information exchange. Clay Ritchey, CEO at Verato.