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MassHealth’s Implementation of Interoperability and Prior Authorization Requirements

Here you can find information about MassHealth’s adoption of the CMS Advancing Interoperability and Improving Prior Authorization Processes final rule.

On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Advancing Interoperability and Improving Prior Authorization Processes final rule. This rule requires MassHealth to implement several Application Programming Interfaces (APIs), improve the timelines for processing prior authorizations, and make certain metrics annually available. The final rule also allows MassHealth members to have more access to their health care information through a third-party application of their choice.

What you need to know

CMS Interoperability Requirements  Prior Authorization Process Changes and Metrics 

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