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Preparing for Mandated 2026 CMS Interoperability Requirements

HEALTH CHAIN INSIGHTS

Preparing for Mandated 2026 CMS Interoperability Requirements

November 27, 2023 | 2-minute read

End-to-End CMS Compliance

During the next two years, Medicare Advantage plans and other impacted++ plans will prepare to implement several CMS mandates. One of the notable patient-facing requirements concerns prior authorization (PA). The requirement’s intent is to help patients better understand their insurance company’s PA processes and the potential impact on their health care. The table below highlights relevant Health Chain products that health plans should consider implementing to:

  • Ensure compliance with CMS regulations

  • Improve plan member satisfaction

  • Streamline provider reimbursement and claims processing

Mandated 2026 Patient Access Prior Authorization (PA) Requirements
PA status
Date of PA approval or denial
Date or circumstance under which the PA ends
Items and services approved
The quantity used to date under the PA, excluding PA decisions for drugs
Health Chain Products Supporting CMS 2026 Interoperability Requirements
HC Prior Authorization Suite
Omega Patent Access App
Plasma Claim Connect
Centaur
Payer to Payer Hub
++ Medicaid Managed Care Plans , Children’s Health Insurance Program (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)

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