Beyond 0057 Compliance: Translating Mandated APIs into Impact. Sponsored by InterSystems

Mandated APIs are only the starting point for transforming prior authorization. In this WEDI virtual spotlight, sponsored by InterSystems, industry innovators will explore how payers, providers, and technology partners can move beyond compliance to deliver measurable improvements in patient access, clinician workflow, and operational efficiency. We’ll begin with a mini session on digitizing medical policies, unpacking how structured, computable content can accelerate automation, improve transparency, and serve as the foundation for modern electronic prior authorization. The conversation will expand into a dynamic panel discussion on innovation in prior authorization, including:

• The role of healthy data in enabling scalable, accurate automation 
• AI-powered adjudication to streamline decision-making and reduce manual review 
• Replacing CQL with next-generation AI for faster, more adaptive rules processing 
• Standardizing Documentation Templates & Rules (DTR) for interoperability and reusability 
• Gold carding programs to reward high-quality providers and reduce unnecessary prior authorization requests 

Attendees will gain a clear picture of how AI, standards, and stakeholder collaboration can work together to transform mandated technology requirements into meaningful, lasting impact across the health sector.

Sessions:

Debunking Tradeoffs between Compliance and Better Care: Leveraging 0057 to Scale ePA and Advance Value-based Care, Steven Berkow, Senior Advisor, Value-based Care, InterSystems, 

With CMS 0057 and HTI-4, policymakers have reaffirmed their bipartisan conviction that better interoperability is key to advancing value-based care and, more specifically, streamlining prior authorization. These regulations establish frameworks that plans, providers, EHR vendors, HIEs, and QHINs must, in turn, detail and apply to achieve these larger aims. InterSystems powers interoperability solutions for all these key stakeholders and will discuss in this session how its cross-section of customers are working to ensure the investment in technology mandated by these regulations transforms prior authorization and supports better care.

De-burdening Documentation: Removing Complexity from DTR Implementation, Stephan Rubin, Director of Product Management, Optum Insights, Optum

The discovery and submission of required documentation is a significant source of frustration for providers in current prior authorization processes and a root cause of complexity. The Da Vinci DTR Implementation Guide (IG) provides an industry-wide roadmap for automating the majority of needed documentation. However, a gap still exists between this roadmap and its implementation in existing plan and provider workflows. Learn how the team at InterQual, a trusted source of evidence-based criteria, is working with leading plans and providers to close this gap—from digitizing medical guidelines to developing tools that help providers identify necessary documentation before submission.

Panel: Opportunities to Transform Electronic Prior Authorization with Artificial Intelligence

• Anna Taylor, AVP, Population Health & Value-Based Care, MultiCare Connected Care (moderator)
• Danny Cawood, Senior Manager, Product Management, MCG Health
• Julie Smith, Senior Manager, Product Management, InterSystems
• Additional Panelists TBA

This panel will explore how artificial intelligence can fundamentally change the landscape by addressing four critical areas: ensuring access to healthy, high-quality data; leveraging AI for faster, more accurate adjudication and decision-making; advancing beyond CQL with AI-driven logic; and standardizing DTR and gold carding to streamline approvals. Join leading experts as they discuss real-world innovations and opportunities to move prior authorization from a compliance exercise to a transformative tool for efficiency, equity, and patient-centered care.