AJMC April 10, 2025
Key Takeaways
- A large portion of payers and providers have not started or are partially through implementing CMS API requirements, with compliance due by January 1, 2027.
- Key challenges include funding, developing a cohesive enterprise strategy, and modifying workflows for interoperability and prior authorization.
- FHIR and X12 are essential standards for electronic health information exchange, facilitating communication across different systems.
- Many stakeholders, including vendors and clearinghouses, plan to assist in meeting API requirements, but significant implementation hurdles remain.
With deadlines looming in 2026 and 2027 for compliance with the CMS Advancing Interoperability and Improving Prior Authorization Final Rule, a survey indicates a concerning lack of readiness among payers and providers to meet the new requirements for data sharing.
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