How-to Guide

Payer's Playbook: CMS Interoperability Final Rule

How to set the foundation for a seamless tech implementation

In January 2024, the Centers for Medicare & Medicaid Services (CMS) published the Advancing Interoperability and Improving Prior Authorization final rule (CMS-0057-F). While payers will need to make some technical decisions – including vendor selection – to comply with the regulatory requirements, they’ll also need to take some important administrative and process actions.

Download the How-to Guide

This how-to guide was designed to help impacted payers start to think about the non-technical action items they’ll need to accomplish over the next two to three years to comply with the final rule, including:

Identify and evaluate current internal systems and/or vendors that maintain or manage your prior authorization data.
Consider and evaluate promotional efforts, member experience, and ease of use of your Patient Access API to increase utilization.
Create and maintain a provider attribution process (and all required educational materials) for Provider Access API.
Create and maintain an endpoint connectivity and vetting process for all payers who want to connect to your endpoint for Payer-to-Payer Data Exchange.

To see the full list of administrative and process actions to take, download the guide.