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  • This page, MassHealth’s Implementation of Interoperability and Prior Authorization Requirements, is   offered by
  • MassHealth

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 (the “Final Rule”). This Final 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.

General Overview

CMS Interoperability Requirements  Calendar Year 2025 Prior Authorization Metrics  

What you need to know: Members

Patient Access API  Provider Directory 

What you need to know: Providers

Prior Authorization Process Changes and Metrics 

What you need to know: Developers

Provider Directory API 

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