Interoperability

Information about interoperability and the final rule is available at these links:

• Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization final rule
• General information about interoperability

Magellan must share certain prior authorization data from the previous calendar year with the public each year. See the prior authorization section below for these details and public report. The data along with additional information includes:

• A list of services that require prior authorization.
• Information about prior authorization requests from the previous year.

This CMS final rule also requires Magellan to implement and maintain a secure, standards-based Patient Access Application Programming Interface (API). This API allows patients to easily access their claims and encounter details. See the Patient Access API section below for these details to include access to the Magellan Health Member Consent Portal. The information available through the Patient Access API includes:

• Healthcare costs, specifically provider remittances and enrollee cost-sharing.
• A defined sub-set of their clinical information through third-party applications of the patient’s choice.