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More time to comply with API requirements The finalized rule requires that both payers and providers update or implement a variety of HL7® Fast Healthcare Interoperability Resources (FHIR®) APIs. In other words, Prior Authorization APIs will be compliant if they use FHIR and X12, or purely FHIR. X12 to FHIR) or small (e.g.
In the State of California, there is a mandate for improved data sharing for smaller entities by Jan 2026, and they are even providing incentives to get it done. FHIR-based API usage by Payers (Government and Commercial) in the next few years will usher in enriched datasets to TEFCA networks. Data-sharing and interoperability are key.
Small physician practices, rehabilitation hospitals, long-term acute care hospitals, acute psychiatric hospitals, small rural acute care hospitals, and nonprofit clinics will have until January 2026. Of note, the XCPD, XCA, and XDR profiles do not currently support FHIR natively.
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