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Interoperability has been a hot topic in the healthcare industry for over a decade and is a constantly recurring theme for organizations as they evaluate potential future technologies and how adopting those technologies will help them meet compliance requirements. The most urgent compliance concerns relate to the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), which has a looming deadline of January 1, 2027.
The final rule’s requirement to implement application programming interfaces (APIs) include payer organizations with some of the tightest budgets in the industry, such as state Medicaid agencies and Children’s Health Insurance Program (CHIP) fee-for-service (FFS) programs. Impacted payers may be concerned about the time, money, and resources needed to meet the conditions outlined in CMS-0057-F. However, healthcare technology partners have solutions available today that can help payers achieve interoperability without disrupting existing processes, creating technical burdens, or requiring investments in costly new systems.
Interoperability is a relatively modern term to the healthcare sector, but it is a concept that has existed within the technology industry since the 1960s. At its most basic level, interoperability is achieved if the following two requirements are met:
- Two entities can exchange data electronically
- A data format is used that both entities understand