Summary
Final rule to improve electronic exchange of health data and streamline prior authorization. Requires covered payers to implement Prior Authorization, Provider Access, and Payer‑to‑Payer APIs; send decisions within set timeframes; and include decision rationales.
Healthcare Implications
Reshapes payer automation where AI is embedded: faster, more transparent prior authorization decisions and standardized APIs support audibility of algorithmic determinations and electronic health record integration. Expect vendor updates and tighter governance for model‑assisted utilization management workflows.