Preparing for new interoperability enhancements coming in 2027

GHP is preparing to implement new interoperability requirements that will make it easier for providers to electronically access member health information and prior authorization data. These enhancements are designed to support more efficient information sharing, strengthen care coordination, and create a more streamlined experience for providers.
Beginning Friday, January 1, 2027, Geisinger Health Plan (GHP) must comply with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). This federal rule changes how health plans make certain member information available to providers and how prior authorization information can be exchanged electronically.
As part of this effort, GHP will introduce secure application programming interfaces (APIs) that allow approved providers and authorized technology partners to electronically request and receive certain member information when a valid treatment relationship exists.

What is CMS-0057-F?

The rule is designed to improve the secure electronic exchange of health information, increase interoperability, and reduce administrative burden for providers, members, and health plans. Under it, impacted payers must implement two key API requirements by January 1, 2027:

• Provider Access API — Enables in-network providers to securely access certain member health information maintained by the health plan.
• Payer-to-Payer API — Supports the exchange of member health information across organizations when a member changes or adds a payer.

GHP is also implementing a Prior Authorization API, which enables the electronic exchange of prior authorization information between providers and GHP.

Which GHP plans are affected?

The rule applies to these GHP product lines:

• Geisinger Gold — Medicare Advantage and Medicaid Managed Care Plans
• GHP Family — State Medicaid Agencies
• GHP Kids — CHIP Agencies and CHIP Managed Care Entities
• Geisinger Marketplace — Qualified Health Plans (QHP) on the Federally Facilitated Exchanges
• Federal Employees Health Benefits (FEHB)

If you treat members enrolled in any of these products, these changes are relevant to your practice.

What the Provider Access API means for you

The Provider Access API lets participating providers securely access certain health information GHP maintains for members. Depending on the member, data availability, and applicable privacy requirements, the information that may be available includes:

• Clinical information — diagnoses, health conditions, allergies, medications, immunizations, lab and diagnostic test results, vital signs, procedures, care plans, treatment plans, and care team information.
• Prior authorization information — authorization requests, request status, approval or denial dates, approved items or services, authorization end dates, denial reasons, and related clinical and administrative information.
• Claims and encounter information — services received, dates of service, providers involved in care, locations where services were provided, and healthcare utilization history.

Access is subject to applicable federal and state privacy requirements and member data sharing preferences.

What is not shared: Some information can’t be shared through the Provider Access API, including drug prior authorizations, provider remittances and patient cost-sharing information, and scanned or faxed documents submitted as part of a prior authorization request. Some information may also not yet be available if it hasn’t been added to GHP’s records at the time of your request.

What the Prior Authorization API means for you

Through the Prior Authorization API, providers may be able to electronically determine authorization requirements, submit prior authorization requests, receive status updates, and obtain authorization decisions. The API is intended to streamline workflows, reduce administrative burden, and improve transparency throughout the authorization process.

What does not change: The API supports more efficient information exchange, but it does not change benefit requirements, medical necessity criteria, coverage policies, or authorization decision-making. The rules governing whether a service requires prior authorization, and whether it is approved, remain the same.

Member privacy and data sharing preferences

By default, member data may be shared via the Provider Access API with in-network providers who have a treatment relationship with the patient. However, members can opt out of electronic sharing of their information. If a member has chosen not to share, data may not be available through this service. GHP shares information in accordance with applicable privacy and security requirements.

What you need to do

To access member information through the Provider Access API, providers or their authorized technology partners will need to complete a registration and verification process. Here’s a high-level summary; detailed instructions will follow in subsequent communications:

1. Register through the GHP Developer Portal — Providers, provider organizations, or their authorized technology partners register through the portal and complete the steps to connect their EHR, application, or authorized technology solution.
2. Confirm a treatment relationship — The provider must be treating or planning to treat the member (for example, the member has an upcoming appointment, referral, consultation, or active episode of care).
3. Request the member’s information — Once registered and the treatment relationship is confirmed, the provider can request the relevant member information.
4. GHP verifies and approves — Before information is shared, GHP verifies the provider’s identity, confirms the treatment relationship, checks whether the member has opted out, and confirms that disclosure is permitted under applicable law.
5. Receive a response within one business day — Once a request is verified, GHP will make the requested member information available within one business day.

You don’t need to take action on these steps today. This overview is meant to give you an early sense of what’s coming so you can begin planning with your EHR vendor or technology partner.

Intended benefits for providers

These interoperability initiatives are designed to deliver tangible benefits to you and the members you serve:

• Improved care coordination
• More complete access to member health information
• Better support for clinical decision-making
• Increased transparency into prior authorization requirements and status
• Reduced administrative burden through standardized electronic data exchange
• Enhanced continuity of care and improved provider experience

What’s next

Over the coming weeks, GHP will share additional communications that go deeper into each topic introduced here, including detailed registration and setup instructions, technical guidance for EHR vendors and technology partners, how to talk to your patients about their data sharing options, Prior Authorization API workflow details, and answers to frequently asked questions.

In the meantime, if you have questions, contact your GHP Provider Relations representative 800-876-5357.

This article is provided for general informational purposes and reflects GHP’s planned implementation of CMS-0057-F as of November 2026. Specific requirements and processes may be refined as we approach the January 1, 2027 compliance date. Watch for future communications with updated and more detailed guidance.