The Standard

HL7's Accelerator CodeX Launches Pilot to Simplify Prior Authorizations in Oncology

Evernorth, Varian Lead Interoperability Efforts between Payers and Providers

Evernorth, the health services business of Cigna Corporation (NYSE: CI), and Varian, a Siemens Healthineers company, are collaborating in the Health Level Seven® (HL7®) FHIR Accelerator™ CodeX to accelerate work that improves data standardization and interoperability in oncology. The two health care companies will lead a radiation oncology-focused pilot project that uses the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard to automate and expedite prior authorization processes between payers and providers.

Prior authorization is a process that improves patient health, safety and affordability by increasing adherence to evidence-based standards of care. Advances in the digitization of health care data, clinical workflows and real-time data exchange between providers and payors have created opportunities to make the prior authorization process easier and faster for all stakeholders. The CodeX pilot will build on this opportunity to improve care for people with cancer who need radiation treatment. 

“We joined CodeX to help drive better communication across the health care ecosystem and continue to optimize prior authorization to meet the needs of providers, patients and payers,” said Eric Gratias, M.D., an oncologist and chief medical officer for eviCore, an Evernorth company that manages medical benefits. “Advancing health data interoperability in oncology is a community effort, and together, we have the opportunity to improve cancer care delivery and outcomes.”

Phase one of the radiation oncology-focused pilot concentrates on breast and prostate cancer and will build and test the exchange of prior authorization information between payer and provider systems using electronic health record test patients. Once validated, phase two will test HL7’s minimum Common Oncology Data Elements (mCODE)-enabled prior authorization workflow in a real-world setting and eventually expand it to additional areas of oncology.

“As a cancer care company, one of our main focuses is on finding ways to accelerate the path from diagnosis to treatment,” said Ashley Smith, Vice President, Oncology Information Systems and Noona at Varian. “That’s why we’re so enthusiastic about participating in this project—because patients stand to benefit in the future.”

Pilot results will inform how providers and payers can apply mCODE-enabled processes to their prior authorization workflows. Providers and payers will benefit from more efficient workflows and less administrative burdens, and patients will experience more timely access to care and improved treatment outcomes.

Clinicians, payers, prior authorization vendors and radiation oncology-specific EHR vendors can join the pilot project to help shape the standard for how prior authorization is implemented before prospective regulatory requirements take effect. Organizations joining CodeX can expect a unique level of influence in the areas of FHIR® development, terminology mapping, clinical expertise and navigating the standards development process. Contact Steve Bratt or Kim Ball for more information.

CodeX members are leading health organizations across the care continuum. The following members are working with Evernorth and Varian on the prior authorization in oncology use case: American Society for Radiation Oncology (ASTRO), the Oncology Nursing Society (ONS), MCG Health, Mettle Solutions, Oncora Medical, Navigate Oncology and Telligen. Select practices in The U.S. Oncology Network will be among the first pilot sites.