[email protected] /+1 (415) 689-8693

Schedule A Demo

Preparing for Mandated 2026 CMS Interoperability Requirements


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
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)

Explore Related Products


HC Prior Auth

Integrated product suite to streamline prior authorization processes for Payers, Providers and Patients.

Read More
Omega Patient Access App

Omega Patient Access App

Supporting Payers in adhering to the CMS Mandate by giving their Members access to their medical records in one place.

Read More
p2p hub

Payer to Payer Hub

Facilitating point-to-point clinical data sharing between Payers at a Member's request.

Read More

Featured Analyst Insight

HC in the Press

Go to Top