Prior authorization has long been one of the most friction-filled processes in healthcare administration – a burden felt acutely by providers, payers, and ultimately patients. Despite years of industry progress on electronic transactions and data standards, prior authorization workflows remain largely manual, point-to-point, and difficult to administer.
That’s why UHIN is proud to be named a participant in the Da Vinci Trebuchet Clearinghouse-to-Clearinghouse (CH-to-CH) Prior Authorization Pilot, launched by the Cooperative Exchange in collaboration with the HL7® Da Vinci Project. A clearinghouse is a secure network hub connecting thousands of payers and providers to streamline the verification, processing, and exchange of healthcare transactions – including prior authorization.
The pilot brings together eleven clearinghouses – including Waystar, Optum, Availity, Veradigm, and others – to test whether HL7® FHIR®-based prior authorization transactions can be operationalized across clearinghouse networks, not just within individual point-to-point connections. The cohort will also validate hybrid X12 and FHIR translation workflows that reflect how the industry actually operates today. The goal is a functional prototype, a clearinghouse implementation playbook, and concrete recommendations for improving the underlying standards, including Da Vinci, FAST Implementation Guides, and X12.
For UHIN, this work is a natural extension of our mission as the state-designated, nonprofit HIE, the Clinical Health Information Exchange (CHIE), and the nation’s only nonprofit clearinghouse network. For providers UHIN, allows for fewer rejections and reduced friction in the claim lifecycle. For payers, UHIN offers a single connection point for clean data. This enhances the delivery of more complete claims, valid codes, and accurate eligibility information, which reduces costly manual interventions.
Clearinghouses have quietly enabled electronic data exchange that we’ve been using for years. We believe they’ve been underutilized as the interoperability infrastructure they already are, and that solving prior authorization at scale starts with the networks clearinghouses have spent years building. Participating in this pilot puts us at the table where those standards are being shaped, not just adopted.
Reducing administrative burden isn’t just an efficiency goal; it has real consequences for patient care. Delays in prior authorization can mean delayed treatment, and the complexity of the current process consumes resources that could otherwise be directed toward improving outcomes. By helping to develop the technological capabilities needed to improve prior authorizations like CH-to-CH routing, identity resolution, and endpoint discovery, UHIN is helping to make the entire ecosystem work better for everyone. We’ll share what we learn along the way.