SDOs & Operating Rules Updates

WEDI to Participate in CMS Listening Session on Prior Authorization Standard, Holding MPA TODAY-November 17. WEDI has been invited to participate in a listening session on prior authorization being held by the Centers for Medicare & Medicaid Services’ (CMS) National Standards Group on December 10, 2025. The listening session will focus on benefits and challenges…

WEDI Holds MPA on Prior Authorization Standard. WEDI held a Member Position Advisory (MPA) facilitated discussion to review questions from the Centers for Medicare & Medicaid Services (CMS) for its December 10 listening session on evaluating the Fast Health Interoperability Resources (FHIR®) prior authorization standard. WEDI, along with the six Designated Standards Maintenance Organizations, was…

Senators Request Information from CMS on Medicare Advantage Provider Directory Issues. Senators Jeff Merkley (D-OR), Ranking Member of the Senate Budget Committee, and Ron Wyden (D-OR), Ranking Member of the Senate Finance Committee, sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz, MD, requesting responses to potential issues with the…

QHIN Technical Framework V2.1 Posted for Review, Responses Due November 7. The Qualified Health Information Network® (QHIN™) Technical Framework (QTF) v2.1 is available for review on the TEFCA Topics in Change Management webpage. Comments on the draft QTF are being accepted until November 7. The Trusted Exchange Framework and Common Agreement™ (TEFCA™) Topics in Change…

CMS Issues Update on Holding of Claims for Affected Services. The Centers for Medicare & Medicaid Services (CMS) provided an update on the processing of claims and payments for services affected by the expired Medicare legislative provisions as of October 1. CMS has instructed Medicare Administrative Contractors to hold these claims but will continue to…

CMS Contracts Signal Commitment to Development of National Provider Directory. On September 30, the Centers for Medicare & Medicaid Services (CMS) awarded four contracts of $1 each to Availity, LLC, Council for Affordable Quality Healthcare, Inc, Gainwell Technologies, LLC, and Palantir Technologies, Inc. The stated purpose of the contracts is to procure information technology services…

OSTP and FDA Request Public Input on AI Use. The White House’s Office of Science and Technology Policy (OSTP) published a Request for Information (RFI) titled “Regulatory Reform on Artificial Intelligence” seeking input on identifying federal legislation, regulations, guidance, or other requirements that impede the development, deployment, and adoption of artificial intelligence (AI) technologies. The…

OCR Settles HIPAA Investigation of PHI Disclosure by Delaware Provider. The Department of Health and Human Services (HHS) Office of Civil Rights (OCR) announced a settlement with a Delaware health care provider for a potential violation of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Breach Notification Rules. The settlement resolves an investigation…

Hear from WEDI Chair-Elect, Denny Brennan, on why interoperability matters in the health care industry.

WEDI is conducting this follow up survey on the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F), and we need your help! This short survey will gauge how the industry is implementing this regulation. Don’t miss this important opportunity to share your perspectives on this significant industry mandate. WEDI’s second survey on…