Advancing Interoperability and Improving Prior Authorization Processes (CMS-10843)

This proposed rule would place new requirements on Medicare Advantage organizations, Medicaid managed care plans, CHIP managed care entities, state Medicaid and CHIP fee-for-service (FFS) programs, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to improve the electronic exchange of healthcare data, and streamline processes related to prior authorization, while continuing CMS’ drive toward interoperability, and reducing burden in the health care market. This proposed rule would also add new requirements for eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program and for Merit-based Incentive Payment System eligible clinicians participating in the Promoting Interoperability performance category of the Quality Payment Program. These policies taken together play a key role in reducing overall payer and provider burden and improving patient access to health information.

The latest form for Advancing Interoperability and Improving Prior Authorization Processes (CMS-10843) expires 2027-04-30 and can be found here.