Regulatory Updates

WEDI is re-activating its Strategic National Implementation Process (SNIP) Testing Task Group, originally deployed to assist the industry implement HIPAA Versions 4010 and 5010 HIPAA transactions. The Task Group is needed as the industry implements the Claims Attachments and Electronic Signature Final Rule, the Interoperability and Prior Authorization Final Rule, and the Version 8060 HIPAA…

BREAKING NEWS: CMS-0062 Proposals in the FY2027 CMS IPPS Final Rule The CMS FY 2027 Hospital Inpatient Prospective Payment System (IPPS) Final Rule, published in the Federal Register on August 4, 2026, finalized updated versions of data exchange standards that were proposed in CMS-0062.  The adopted standards support the interoperability of FHIR APIs for the ePA…

CMS Launches QualTech to Identify Innovative Technology Solutions. The Centers for Medicare & Medicaid Services (CMS), through the Center for Clinical Standards and Quality (CCSQ), launched QualTech, an industry initiative designed to identify innovative technology solutions aligned to quality-related priorities and advance better health outcomes. CMS is inviting organizations with technology solutions or capabilities aligned…

CMS Posts Materials from Listening Session on Advancing Adoption of X12 Version 008060. The Centers for Medicare & Medicaid Services (CMS) posted materials from the agency’s July 1 Listening Session on advancing the adoption of X12’s Version 008060 administrative transactions. WEDI and the six Designated Standards Maintenance Organizations (Dental Content Committee, Health Level 7, National…

OMB Reviewing Final Rules for HTI-5 and Transparency in Coverage. The Office of Management and Budget (OMB) is reviewing two final rules. The first regulation is the Office of the National Coordinator for Health Information Technology’s (ONC’s) “Health Data, Technology, and Interoperability: ASTP/ONC Deregulatory Actions to Unleash Prosperity” final rule, known as “HTI-5.” The proposed…

Key Prior Authorization Policies Finalized in FY2027 CMS IPPS Final Rule. The Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) partnered to finalize key Fast Healthcare Interoperability Resources (FHIR®) electronic prior authorization policies impacting the 2024 CMS Promoting Interoperability and Advancing Prior Authorization Final Rule…

CMS Posts New FAQs on CMS-0057-F, Includes Metric Reporting Template. The Centers for Medicare & Medicaid Services (CMS) posted new Frequently Asked Questions (FAQs) on the Prior Authorization application programming interface requirements in the CMS Interoperability and Prior Authorization (CMS-0057-F) final rule. Included in the FAQs is information on the public reporting by impacted payers…

CMS Releases CY2027 Medicare PFS Proposed Rule. The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2027 Medicare Physician Fee Schedule (PFS) proposed rule. In addition to the physician payment proposals, other proposals address value-based care programs and Medicare accountable care organizations (ACOs). Proposed improvements to the Medicare Shared Savings Program…

OMB Releases 2026 Federal Regulatory Unified Agenda. The Office of Management and Budget released the 2026 Unified Agenda of Federal Regulatory and Deregulatory Actions (Unified Agenda). The Unified Agenda identifies the regulatory actions under development by the various Departments. For the Department of Health and Human Services, items in the 2026 Unified Agenda include potential…

WEDI Presents at CMS Listening Session on X12 Version 008060. WEDI presented at a Listening Session conducted by the Centers for Medicare & Medicaid Services (CMS) Office of Health Technology and Products on the topic of adopting the X12 Version 008060 standards under the Health Insurance Portability and Accountability Act. WEDI was invited to present…