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Health plans face a January 2026 deadline to meet CMS’s new prior authorization mandates. GenHealth outlines a faster, more affordable alternative using FHIR DocumentReference + Binaries and AI—achieving >95% accuracy, 10x lower costs, and real-time turnaround without relying on outdated Da Vinci standards.
This guide outlines the integration of GenHealth's UM/PA application with FHIR servers to meet CMS's 0057f regulations for prior authorization and utilization management. It provides detailed diagrams and explanations for implementing Da Vinci-compliant APIs, covering CRD, DTR, and PAS workflows to help health plans achieve faster turnaround times and improved transparency in the prior authorization process.