September 1, 2022 – Evernorth, the health services business of Cigna Corporation, and Varian, a Siemens Healthineers company, are collaborating in the Health Level Seven® (HL7®) FHIR Accelerator™ CodeX to accelerate work that improves data standardization and interoperability in oncology. The two health care companies will lead a radiation oncology-focused pilot. project that uses the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard to automate and expedite prior authorization processes between payers and providers.
Prior authorization is a process that improves patient health, safety and affordability by increasing adherence to evidence-based standards of care. Advances in the digitization of health care data, clinical workflows and real-time data exchange between providers and payors have created opportunities to make the prior authorization process easier and faster for all stakeholders. The CodeX pilot will build on this opportunity to improve care for people with cancer who need radiation treatment.
Phase one of the radiation oncology-focused pilot concentrates on breast and prostate cancer and will build and test the exchange of prior authorization information between payer and provider systems using electronic health record test patients. Once validated, phase two will test HL7’s minimum Common Oncology Data Elements (mCODE)-enabled prior authorization workflow in a real-world setting and eventually expand it to additional areas of oncology.
Pilot results will inform how providers and payers can apply mCODE-enabled processes to their prior authorization workflows. Providers and payers will benefit from more efficient workflows and less administrative burdens, and patients will experience more timely access to care and improved treatment outcomes.
Clinicians, payers, prior authorization vendors and radiation oncology-specific EHR vendors can join the pilot project to help shape the standard for how prior authorization is implemented before prospective regulatory requirements take effect. Organizations joining CodeX can expect a unique level of influence in the areas of FHIR® development, terminology mapping, clinical expertise and navigating the standards development process.