OmniCompli ePrior Authorization | Smile Digital Health

ePRIOR AUTHORIZATION

Prior Authorization, Embedded in the Clinical Workflow

OmniCompli ePrior Authorization embeds Payer requirements under CMS-0057-F into existing clinical workflows. Delivered as a SMART on FHIR® app, ePrior Authorization launches within the EHR, which remains the system of record, and communicates through a managed payer gateway. It is built on HL7® FHIR, Clinical Quality Language (CQL), and Da Vinci Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR) and Prior Authorization Support (PAS) Implementation Guides (IGs).

For EHR Vendors, ePrior Authorization provides a reusable, standards-based architecture that reduces the need for separate customized technical integration projects. Provider-side workflows connect securely to the prior authorization APIs and workflows that Payers must offer under CMS-0057-F.

For Providers, payer coverage requirements are checked, and the questionnaire is pre-populated from authorized EHR FHIR data before returning to the clinician. ePrior Authorization reduces clinical and administrative delays, friction and improves documentation completeness.

For Payer delegates, the FHIR and CQL-based API proxy ensures existing adjudication systems remain in place, integration efforts are contained, and a defensible compliance plan is established in time for the January 1, 2027 CMS-0057-F compliance date.

The Prior Authorization Challenge

Prior authorization remains fragmented across Payer and Provider systems causing delays and friction. Providers must locate data across multiple systems, and use different portals to re-enter clinical information and track order status. EHR vendors are facing heavy technical labour involving building CRD, DTR and PAS integrations that must connect with multiple Payer systems, and meet certification requirements. Payer delegates must modernize legacy prior authorization workflows, navigate partner-controlled routes and codify policy content, prior to the January 1st 2027 CMS-0057-F deadlines.

With CMS-0057-F API requirements taking effect in 2027 and electronic prior authorization measures becoming mandatory for eligible hospitals in 2028, organizations face a compressed timeline to meet new requirements, and resolving existing workflow and integration challenges.

What EHR Vendors Get

System of Record - the EHR remains the system of data and records.

Reduced Integration Effort - Standards-based interoperability across CRD, DTR and PAS ensures reusable development across every connected Payer.

Faster Provider Adoption - Deployed through Smile-hosted infrastructure, the implementation and maintenance burden for EHRs is reduced

Certification Ready - Built to the HTI-4 electronic prior authorization criteria.

For Providers

Less Administrative Work - Payer requirements and clinical data are pre-populated, reducing chart-chasing, manual entry and duplicated paperwork.
Prior Authorization Within the EHR - Clinical data, order workflows and records are maintained within EHR.
More Complete Submissions- Authorized EHR FHIR data is pre-populated for clinicians.
Simplified Payer Connectivity - A single managed payer gateway for all Payers.

"Smile's steadfast dedication to open standards perfectly aligns with MiHIN’s unwavering drive to establish a forward-looking and market-responsive HIE, facilitating the seamless integration of clean, actionable data, real-time quality measures, point-of-care clinical insights, and more."

Dr. Tim PletcherExecutive Director of MiHIN