ADA seeks input on proposed CMS rule on interoperability, prior authorization
Dental stakeholder call to take place May 21
The American Dental Association is seeking input from dental stakeholders on a proposed Centers for Medicare & Medicaid Services rule on interoperability standards and prior authorization for drugs.
The ADA will host a call from 3-4:30 p.m. CDT May 21 to collect feedback to help inform its response to CMS about the rule, which aims to streamline the prior authorization process for prescription drugs; mandates specific Health Level Seven International Fast Healthcare Interoperability Resources, or HL7 FHIR, and National Council for Prescription Drug Programs standards by Oct. 1, 2027; and introduces increased transparency reporting. The public comment period for the proposed rule will close June 15.
During the call, ADA staff will facilitate discussion on key topics within the rule, including:
• FHIR transition: The rule proposes replacing the current electronic prior authorization standard with a new FHIR-based system, affecting every dental office that submits prior authorizations electronically. The ADA will seek feedback on what this means for the software dental offices rely on daily and whether the proposed compliance timeline is achievable.
• Direct Data Entry portal exception: CMS is considering eliminating the exception that currently allows dental offices to submit data for claim submissions, benefit verification and other transactions, including prior authorizations, through payer web portals. The ADA will seek feedback on the risks this poses for small and rural practices and how best to frame the dental industry's position.
• Cybersecurity for small practices: CMS is soliciting input on healthcare cybersecurity, and dental offices face distinct vulnerabilities. The ADA will seek feedback on how to effectively represent the dental industry's needs in this section of the rule.
Interested parties need to register in advance for the call. After registering, they will receive a confirmation email with instructions for joining. Questions or concerns can be directed to standards@ada.org.
