Preparing for new interoperability enhancements coming in 2027
Effective date
Jan 1, 2027
Identified
Nov 7, 2026
Summary
Geisinger Health Plan (GHP) announced it will implement CMS-0057-F interoperability requirements, including a Provider Access API for in-network providers and a Prior Authorization API for electronic prior authorization exchange, with compliance beginning January 1, 2027 for Geisinger Gold (Medicare Advantage and Medicaid managed care), GHP Family, GHP Kids, Geisinger Marketplace, and FEHB products. Providers and their technology partners will need to register through the GHP Developer Portal and confirm a treatment relationship before member data can be requested; the publication says prior authorization requirements and decision criteria are unchanged.
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01By 2027-01-01: Billing team and practice leadership should contact their EHR vendor or technology partner to plan for GHP Provider Access and Prior Authorization API connections, and confirm with the front desk and providers which GHP product lines (Geisinger Gold, GHP Family, GHP Kids, Geisinger Marketplace, FEHB) the practice bills so workflows can be scheduled.
02Watch for GHP's forthcoming registration instructions on the GHP Developer Portal and prior authorization workflow details, and contact GHP Provider Relations at 800-876-5357 with questions.
03Prior authorization requirements themselves are stated as unchanged, so existing prior auth submission and charge entry processes should continue until GHP's detailed guidance is received.
Original notice
Preparing for new interoperability enhancements coming in 2027
geisinger.org · Always check the source before changing claims.
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