The proposed Interoperability and Prior Authorization rule has the potential to help payers, providers and patients. Prior authorization from payers is required before providers can render certain types of services to the patients. It has become an administrative burden to obtain the authorization and has hampered the flow of healthcare delivery.
Providers expend valuable resources in recognizing the payer-specific treatments requiring prior authorization and doing the paperwork to obtain the approval. Due to the complexity of the process, it has led to patients not receiving the required treatment at the right time or abandoning the treatment plan.
With the proposed rule, prior authorization can be fully digitized. It will reduce the time taken to obtain the authorization as well as the resources expended. Providers can use their resources efficiently in delivering care and patients will be able to receive the treatment they require without the hassle.
The proposed rule requires payers to maintain FHIR-enabled APIs to easily locate the treatments that require prior authorization and to send and receive prior authorization requests and responses. It also requires payers to report prior authorization metrics. FHIR standard interoperability is key for payers to equip themselves with this technology.
RapidFire, an interoperability platform, can help payers comply with the rule. With FHIR-enabled data aggregation system combined with high-performing analytic capabilities, RapidFire can be customized to build FHIR APIs and obtain prior authorization metrics. RapidFire is highly secure and complies with the HIPAA regulations.
Aigilx health specializes in developing Interoperability solutions to create a healthcare ecosystem and aids in the delivery of efficient, patient-centric and population-focused healthcare.