Jacksonville, FL – March 27, 2024 – Availity, the nation’s largest real-time health information network, announced a comprehensive suite of technology solutions and services designed to assist health plans and providers in achieving compliance with the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F), which was published on January 17, 2024.
“Availity recognizes the importance of this rule in accelerating the adoption of new standards that can reduce burden for both payers and providers,” said Susan Bellile, Principal of Interoperability at Availity. “We are committed to leveraging our expertise and technology to support our clients through this transition.”
The Final Rule aims to enhance interoperability and streamline the prior authorization process by mandating certain health plans to implement specific Health Level Seven International® (HL7®) Fast Healthcare Interoperability Resources (FHIR®) APIs.
Additionally, the Final Rule includes incentives for clinicians and hospitals to utilize FHIR APIs for future authorization requests, as well as new “process” requirements that apply to all prior authorizations managed by the impacted payers.
Health plan organizations impacted by the Final Rule include Medicare Advantage (MA) organizations, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and issuers of Qualified Health Plans (QHPs) offered on Federally Facilitated Exchanges (FFEs).
“We are excited to expand our offerings to include new FHIR-based solutions that will deliver on industry goals for interoperability,” added Bellile. “Availity’s focus has always been on improving the healthcare experience by facilitating effective and efficient communication between payers and providers. With billions of transactions processed through Availity each year, we are uniquely positioned to support the healthcare industry in best meeting these new requirements.”
Health plans and providers interested in learning more about Availity’s solutions that can help achieve compliance with the CMS Interoperability and Prior Authorization Final Rule are encouraged to visit Availity’s Payer-to-Payer Exchange website.
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Availity is the trusted partner for organizations seeking to realize the greatest value from clinical, administrative, and financial data. Positioned at the nexus of provider, health plan, and consumer health information, Availity develops scalable, innovative solutions for healthcare data acquisition, standardization, transparency, automation, and exchange among health plans, providers, and technology partners. As one of the nation’s largest health information networks, Availity facilitates billions of clinical, administrative, and financial transactions annually. Our suite of dynamic products, built on a powerful, intelligent platform, enables real-time collaboration for success in a competitive, value-based care environment.
For more information, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548). Follow us on LinkedIn and X.
Matt Schlossberg
Director of Public Relations, Availity
630-935-9136
[email protected]
Jill Colna / Jill Anderson
SVM PR
401-490-9700
[email protected]