MedCity News December 4, 2025
The go-to mechanisms for differential payment – network design, case management, quality measurement and prior authorization – increasingly rely on APIs capable of handling not only claims data but, more importantly, the clinical data critical to intelligent decision-making.
I was getting my annual flu shot at my local pharmacy recently and the visit served as a microcosm of healthcare IT at the front lines. My vaccination was seamlessly registered in both the pharmacy’s online system and the state HIE, the IT worked as intended. Meanwhile, another customer was engaged in a long discussion with the pharmacist over inconsistencies in the duration of her chronic medication prescription, caused by computerized payment rules and resulting confusion over the copay. Multiple trips to...
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