Our guests are Amanda Clifton, Vice President, Technology Solutions, Automation and Core Workflow and Jeffrey Bostelman, Staff VP Interoperability, Clinical Strategy & Architecture, at Centene Corporation.

In this episode, Amanda and Jeff explore the opportunities and challenges of payer-to-payer data exchange and price transparency regulations.

On January 17, of this year, the Centers for Medicare & Medicaid Services (CMS) finalized the Interoperability and Prior Authorization Final Rule, a significant step towards improving member data exchange and delivering holistic care experiences.

With the January 1, 2027, mandatory enforcement date approaching, failure to take proactive steps could result in substantial penalties and connectivity delays. This underscores the urgent need for health plans to act swiftly and decisively to address the challenges and hurdles in establishing secure connections with other health plans.

Price transparency is a series of national policies designed to create a patient-driven healthcare system by making health plans and hospitals in the U.S. more transparent, so patients can better understand what they will pay for goods and services.

Consumerism is built on the tenet that patients have full access to cost and pricing information to make decisions about their health, and these new laws are likely just the start of a series of regulatory initiatives designed to mandate pricing transparency.

Thoughts? Guest suggestions? Email us at matt.schlossberg@availity.com

This episode of “Availity On-Air” was produced by Availity LLC. Research by SVM Public Relations & Marketing Communications. Our editor is Kevin McDonald. The show’s production team also includes Travis Froehlich & Derrick Nevado.

Learn More

• Availity’s Interoperability Solutions Payer-to-Payer Hub and Prior Authorization Requirements, Documentation, and Decision (PARDD). This webinardelivers an overview of Availity’s approach to two mandates in the CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P), also referred to as Interop 3.