Real Interoperability APIs
What are interoperability APIs?
Interoperability APIs are standardized interfaces that enable real-time exchange of healthcare data across systems using HL7 standards. Built on FHIR (Fast Healthcare Interoperability Resources®), they are aligned with CMS-0057 (Advancing Interoperability and Improving Prior Authorization Processes) and applicable state regulations. These APIs help reduce administrative burden, support continuity of care as members change plans, and improve coordination across the healthcare ecosystem.
Why are interoperability APIs important now?
FHIR APIs are required to meet CMS interoperability mandates and enable secure, real-time data access across payers, providers, and third-party applications.
What regulatory requirements are driving this?
These APIs support CMS Interoperability and Prior Authorization Final Rule requirements, including end-to-end prior authorization capabilities by January 1, 2027.
What business problems do these APIs solve?
• Fragmented data across systems
• Delayed or asynchronous workflows
• Lack of transparency (status, requirements, next steps)
• High administrative burden
What capabilities will interoperability APIs enable for providers?
• Real-time eligibility, benefits, and prior authorization requirements
• Digital prior authorization submission and status tracking
• Access to claims and clinical data
• Direct integration into EMR/EHR and RCM workflows
How is this different from current APIs or EDI?
• Interoperability APIs: Real-time, standardized, and workflow-integrated
• Legacy APIs/EDI: Batch-based, fragmented, and reliant on manual mapping
Interoperability APIs consolidate and simplify integration into fewer, purpose-built APIs aligned to the revenue cycle.
How will providers access interoperability APIs?
Providers or their vendors, such as EHR, RCM, or clearinghouses will integrate directly with APIs, embedding workflows into their existing systems.
How does this improve provider experience?
• Consolidates and simplifies integration into fewer, purpose-built APIs aligned to the revenue cycle
• Increased transparency and confidence
• Faster, more predictable decisions
• Reduced “what do I do next?” inquiries
• Lower administrative burden
Are interoperability APIs secure?
• Authentication and authorization
• Consent management
• Secure access for third-party apps