Proponents of Fast Health Interoperability Resources (FHIR) say the information exchange standard is a leading candidate to facilitate information exchange, particularly when it comes to efforts to remove the barriers that make prior authorization difficult. The emerging standard holds promise in helping payers and providers move patient information seamlessly to make care reimbursement decisions.
In the midst of that effort is Tony Sheng, vice president of interoperability solutions for ZeOmega and member of HL7’s Da Vinci Project. At a recent Da Vinci Project community web-based meeting, Sheng and fellow Da Vinci member, Change Healthcare’s Craig Knier, demonstrated the use of FHIR and application programming interfaces (APIs) to enable real-time prior authorization between providers and payers.
The effort to incorporate FHIR to solve vexing prior auth challenges is significant because relatively few such communications between providers and payers are accomplished in even a partially automated way. Most of these intricate transactions are time-consuming, labor-intensive and put many patients at risk while they are waiting for their care to be approved, trade groups say.
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