With the enforcement date for CMS-0057-F quickly approaching, many Payers are discovering a critical compliance gap: their proprietary Prior Authorization solutions do not serve out-of-network providers. Payers who have turned to proprietary solutions for CMS and Prior authorization compliance, are often only able to support providers on the same system, leaving workflows and adjudication with out-of-network providers at risk of non-compliance.
To avoid paying for and maintaining multiple, fragmented solutions, forward-looking Payers are turning to vendors that offer FHIR-native, EHR-agnostic platforms—designed from the start to align with Da Vinci CRD, DTR, and PAS implementation guides.
Smile Digital Health’s CMS and Prior Authorization solutions are built on a FHIR-first platform in alignment with HL7® Da Vinci Standards for Prior Authorization.
Our solutions are designed to give Payers 100% coverage for both in-network and out-of-network providers within one platform. They are EHR-agnostic, ensuring seamless interoperability across provider systems without requiring providers to adopt or invest in new technology.