CMS and the Office of the National Coordinator for Health IT (ONC) have released a proposed rule that would outline new requirements for the electronic exchange of health care data. The proposal is segmented into five parts and includes:

  1. Requiring CMS-regulated payers include information on patients’ pending and active prior authorization decisions in their Patient Access APIs;
  2. Requiring payers build and maintain a Provider Access API for better payer-to-provider data sharing of claims and encounter data (not cost data);
  3. Refining the prior authorization process to make it more efficient and transparent, beginning in January of 2023;
  4. Clarifying payer-to-payer data exchange requirements;
  5. Adopting Health IT standards and implementation specifications from the ONC by HHS.
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