BCP Solution

    CMS Interoperability and Prior Authorization Accelerator

    Prepare payer systems, data mappings, API workflows, and reporting operations for modern interoperability and prior authorization requirements.

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    CMS Interoperability & Prior Authorization Accelerator
    Who it helps

    Built for teams who need outcomes, not just tools

    Health plans and TPAs preparing for CMS interoperability rules
    Providers exchanging clinical and prior authorization data with payers
    Vendors and platforms supporting payer-provider data exchange
    Problems & deliverables

    What this solution addresses and produces

    Problems it solves

    • Payer-provider data exchange gaps and inconsistent FHIR readiness
    • Fragmented prior authorization workflows across systems
    • Reporting obligations without trusted source data
    • Auditability and evidence gaps across API workflows
    • Vendor coordination and implementation sequencing

    What BCP delivers

    • Current-state assessment of APIs, data, and workflows
    • FHIR resource mapping for Patient, Coverage, Claim, and PA exchange
    • API workflow design for Patient Access, Provider Access, Payer-to-Payer
    • Prior authorization data and reporting model
    • Test plan, conformance approach, and implementation roadmap
    • Compliance evidence checklist and vendor coordination plan
    How implementation works

    The CMS Interoperability process

    1. 01

      Assess

      Inventory APIs, FHIR readiness, data sources, and existing workflows.

    2. 02

      Design

      Map FHIR resources, API contracts, security, and PA workflows.

    3. 03

      Validate

      Build test plans, conformance approach, and trace evidence.

    4. 04

      Implement

      Coordinate vendors, deploy in stages, and verify exchange.

    5. 05

      Operate

      Stand up monitoring, reporting, and evidence repository.

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    FAQ

    Frequently asked questions

    Schedule a CMS Readiness Review

    Tell us what you are trying to connect, modernize, automate, or govern. BCP will help identify the fastest practical path from fragmented systems to trusted operations.

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