Cut Paperwork, Not Care.
Shared, neutral utility infrastructure for healthcare interactions.
Healthcare digitized the organizations. Now we need to digitize the interaction between them. Find each other. Trust each other. Transact. Connect once. Work across the market. Prior authorization is first — start testing now.
American healthcare still runs on faxes, phone calls, portals, and thousands of one-off connections — clinicians lose hours to paperwork, and patients wait, often in the dark, on decisions that should take minutes. As each participant and market activates, one network connection replaces separate bilateral connections.
A neutral utility. No payer, health system, or vendor controls it. It can’t open what it carries — the keys stay at the edges. Patient rights stay with the patient.
Governed for perpetual independence and neutrality.
Delaware moved first — program announced July 6, network testing launched July 13, first production cohort targeted January 1, 2027. The network opens state by state — starting with insurance verification and prior authorization, as CMS-0057 API compliance dates begin in 2027.
Delaware Launch & Connectathon — what happened
More than 200 participants, in person and online, at the University of Delaware on July 13. The first health plan connected and began testing prior-authorization workflows; a state HIE connected self-service, straight to the hub; providers, networks, and HIEs are connecting — all on synthetic data, end to end.
Read the recap →American healthcare runs on faxes.
Healthcare’s data systems were built to talk to themselves, not to each other.
There’s no shared hub — no single connection a payer or provider can join once to reach everyone else. So every payer builds a separate connection to every provider, and every provider to every payer: thousands of point-to-point integrations, rebuilt again and again for every transaction. A large health system amortizes that paperwork across whole departments; a small or rural practice absorbs the same burden at a front desk of one.
Patients were an afterthought. Here’s the bill:
From a recorded Delaware prior-authorization call, May 15, 2026:
Dr. Hockstein: “You don’t have my note. You have no clinical information on this patient?”
Reviewer: “I have nothing attached to this patient’s requests — and this is why we said we could not approve the request.”
Dr. Hockstein: “So it was denied without asking for additional information?”
— Neil Hockstein, MD · Delaware Surgeon General · Health Care Commission Chair · practicing head & neck surgeon
The note wasn’t missing. The bridge was.
One of the most familiar sentences in American medicine remains: “We’d love to approve this — can you fax us the clinical notes?”
The network’s target is the administrative-waste share of that bill — the paperwork, not national health spending writ large.
Every system knows what happened inside it. No shared layer knows what’s happening between them. See how it works →
Healthcare already has EHRs, payer platforms, HIEs, clearinghouses, cloud platforms, analytics, AI agents, and consumer apps. Every system knows what happened inside it. No shared layer knows what’s happening between them.
January 1 is a fork in the road. Health plans across the country are implementing CMS-0057 — new federal requirements to make prior authorization work through modern APIs beginning January 1, 2027. The APIs are becoming standard. How everyone connects to them is not. The default: N-by-N — another generation of point-to-point connections and portals. The alternative: N-by-1 — connect once, transact with all.
The solution: one connection, every enabled counterparty. Participants keep their systems, workflows, and data. SHN operates interaction state, authority, and coordination — with attribution, receipts, and audit. The common path should make the market reachable — not replace the systems already in it. Visa-like reach. Utility-like governance.
Every party connects to every other party. Thousands of point-to-point integrations.
Every party connects once.
The Hub routes — and stays payload-blind.
From N-by-N to N-by-1. Connect once, transact with all.
Records aren’t pooled centrally. When documentation must travel for a transaction, it moves sealed between the parties that need it — not into a central record store.
Sealed envelopes, no central store. Every transaction travels in a sealed envelope the hub can’t open — and the network never builds or stores a database of anyone’s records.
Built so patients can see network-routed requests about them — who asked, when, and why. This is not just faster prior authorization — it is the standardized status evidence for prior authorization that patients can track through participating applications, as those surfaces are enabled.
Operated as a common utility — not a vendor’s product.
- Synthetic-data sandbox (opened July 1)
- Free CMS-0057 Readiness Check — per-scenario pass/fail across the eight prior-authorization use cases
- End-to-end prior-authorization test flow
- Delaware network testing launched July 13 — 200+ participants; first health plan connected to the test network and began testing; providers, networks, and HIEs connecting to the hub
- Public documentation and open-source gateway artifacts
- Local Test Kit — create a free developer account and see the workflow run on synthetic data in minutes
- Jan 1, 2027 — targeted launch: prior-authorization routing for launch participants; CMS-0057 readiness suite available for the January cohort
- Target expansion roadmap — full CMS-0057 suite, claims, pharmacy PA, quality reporting — subject to participant readiness and governed release approval. The catalog & calendar →
Target release calendar, subject to launch-participant readiness and governed release approval.
Start testing today. Don’t let the January deadline go to waste.
You don’t need a production agreement to begin testing the network. The sandbox is open: synthetic data, CMS-0057 Da Vinci workflows.
Start simple. Deepen over time.
Keep the systems and standards-based APIs you already use — one shared network connection makes them reachable across the market.
Payers begin on the sandbox APIs they’re already building for CMS-0057, then choose who runs their Gateway — deployed in infrastructure they control, or authorized to a qualified HIE, cloud environment, technology partner, or managed operator — and shared testing is itself the first saving: conformance is established once against the network, not proven counterparty by counterparty. Providers begin in the cloud sandbox, then connect through their FHIR server, their EHR’s native Da Vinci API, or a SMART on FHIR app. You can deepen how you connect without starting the relationship over.
No local infrastructure; self-service client registration; synthetic data only. Validate CRD/DTR/PAS construction against the available test routes.
Start in the cloud sandbox →Prove deployment: run the gateway in your environment — keys generated and retained locally — connect the EHR or payer sandbox, and validate full EHR/payer → gateway → hub routing and conformance.
Set up a local gateway →Many teams do both: cloud first to prove the requests, local second to prove the deployment.
The Battle of the Revenue Cycle Bots is already underway.
The current response from health systems and payers is to deploy AI on both sides — AI agents drafting prior authorization requests, AI agents evaluating them. Robots faxing robots.
The answer isn’t less AI — it’s AI on shared rails. AI can reason — it still needs recognized authority to act. SHN makes legitimate machine action easier than credential sharing, scraping, or impersonation. Read the perspective →
One connection gets more valuable as the network grows.
Prior authorization is first. But every new transaction, participant, and market increases the value of your connection.
Washington set the requirements. Smart Health Network is the shared path to 0057 readiness — and the network beyond it.
The federal Interoperability and Prior Authorization rule requires impacted payers to support electronic, FHIR-based prior authorization, meet defined decision timeframes, and report their performance publicly — with API compliance dates beginning January 1, 2027. CMS has been clear that getting there is not a job any one organization can do alone.
“Prior authorization won’t be fixed by technology alone. It requires the entire healthcare system to work together to solve real-world challenges.”
That is exactly what a shared hub makes possible. Smart Health Network has pledged to support the CMS Health Technology Ecosystem — and we’re building the connective layer that turns each organization’s readiness into working, cross-sector exchange. The payers and providers preparing for 2027 can connect once and reach every enabled, authorized counterparty, instead of building one-to-one, plan by plan. The nation’s major payers have also publicly pledged to streamline prior authorization on the same timeline — one connection supports both the mandate and the pledge. State legislatures are moving the same direction: prior-authorization laws are now on the books in some forty states, with more advancing every session. But if every payer complies separately, fragmented APIs are just fax machines in modern clothing — and the deadline is only the first mandate the rails absorb: on the network, a new requirement becomes a network release, not another bespoke compliance build.
One network, every party at the table.
Pay for additional utility value. Not for permission to reach one another.
Core + Open Access — $0 SHN fees
Patients: no fees, ever. Core network services, gateway software for Core and Open Access use, and designated Open Access interactions — including CMS-0057 prior authorization, permanently — carry no SHN network or transaction fee.
Utility Fees
Recurring payment for recurring network-wide operating value across a covered population, program, portfolio, or enterprise. $0.25 PMPM Launch · $0.50 PMPM Standard — only when a covered population activates a defined paid Utility.
Capabilities & Services
Specialized evidence, analytics, implementation, managed infrastructure, and other differentiated work — separate, disclosed economics, performed by SHN or qualified ecosystem partners.
The state decides whether CMS-0057 stays fragmented.
Every impacted payer is already investing in CMS-0057 capability. The state decides whether those capabilities remain fragmented at the provider edge or become reachable through one shared path. States feel the administrative burden first: rural hospitals waiting on approvals, Medicaid programs managing fragmented payer rules, and patients caught between systems that do not talk to each other — and the federal Rural Health Transformation Program put $50 billion on the table for states that show CMS a credible plan they’re actually implementing.
1 — Join · 2 — Activate the Market · 3 — Connect State-Sponsored Health Plans · 4 — Accelerate Provider Adoption (optional — RHTP states)
Prior authorization is the first transaction, not the program. The same shared rails carry prior authorization in January, then claims and remittance, pharmacy prior authorization, and quality and value-based reporting on the target release calendar — subject to launch-participant readiness and governed release approval.
Delaware moved first.
Delaware moved first: the statewide program was announced July 6, network testing launched July 13, and the first production cohort is targeted for January 1, 2027 — real-time insurance verification and prior authorization through a neutral shared hub connecting clinicians, payers, health systems, and patients. The Department of Health and Social Services and the Delaware Health Care Commission are building it through DHIN, the state’s trusted health information exchange, and the Smart Health Network.
Delaware didn’t choose a vendor — it wrote shared, neutral infrastructure into its federal Rural Health Transformation plan, and it is building on infrastructure the state already trusts.
“The promise here is simple: cut the paperwork, not the care.”
Delaware’s published Year-3 targets: 75% reduction in prior-authorization response time · 85% clean claims rate · 90% reduction in coverage-error first-pass denials.
Markets launch by state, on scheduled releases — each launch cohort has named participants and a defined minimum production scope, and additional participants activate continuously after launch. Early market-forming activations qualify for published Launch Utility pricing.
Designed to be neutral, patient-first, non-capturable, and sustainable in perpetuity.
The reason American healthcare ended up where it is — patient data scattered across thousands of unconnected silos, controlled by parties whose financial incentives often diverge from the patient’s interest — is not that anyone meant for it to happen. It is that no one designed the structure to prevent it.
Smart Health Network is built with that lesson absorbed at the foundation: four independent constitutional institutions, separated by design.
Three questions worth asking of any shared infrastructure that connects providers, payers, and patients:
Who does the obligation run to?
Patients. The Data Rights Trust holds fiduciary duty directly to individuals — not to the operator, not to payers, not to providers.
Can it be captured?
No. Constitutional separation of powers, with reserved powers separated by design. No ordinary acquisition path can override the mission lock, patient rights, or neutrality covenants.
Does the price tend toward the lowest sustainable cost?
Yes. SHN PBC operates the rails as a utility at minimum sustainable cost. Published pricing principles and schedules apply to every comparable participant. Surplus is reinvested, not extracted. Investor returns are capped, so no one profits from raising the fee.
These are not promises. They are architecture. Promises can be renegotiated. Architecture is what is left when promises run out.
Build on the network.
Smart Health Network runs on open standards — HL7 FHIR today, with X12 arriving at the edges alongside the April claims release — so the work your systems already do for CMS-0057 and Da Vinci makes you ready to connect. One connection reaches every authorized participant; the network provides the common identity, authorization, and audit framework. The sandbox is open now — synthetic data, self-service registration. Connect directly, or through a certified partner — same network, same conformance, same Open Access rights. →
Built by people who have done this before.
The team behind Smart Health Network has built and operated real-time health infrastructure at national scale — across providers, payers, and the standards bodies that govern how health information moves. Meet the people →
Join us in building the digital foundation for the future of health.
“The question is not whether digital transformation will occur — it is essentially inevitable. … We can intervene now and organize the healthcare industry and regulatory levers around a digital and data architecture to create a better health future for all.”
Get in touch — tell us who you are and we’ll follow up. The network opens to additional participants in phases.
Smart Health Network PBC · A mission-locked Delaware Public Benefit Corporation