Cut Paperwork, Not Care.
Neutral infrastructure that connects providers, payers, and patients — built to help the industry modernize prior authorization ahead of the federal 2027 deadline, with patients and clinicians able to see every request.
Smart Health Network is shared digital infrastructure connecting providers, payers, and patients through one shared hub. Data stays at the source. Questions route to where the data lives; answers come back the same way. The network is built so patients can see what was asked, what was decided, and who accessed their information.
Operated as a common utility.
Governed for perpetual independence and neutrality.
Healthcare’s data systems were built to talk to themselves, not to each other.
There is no shared hub in American healthcare — no single connection every payer and provider can join once to reach all the others. Every payer connects separately to every provider. Every provider connects separately to every payer. The mathematical shape is N-by-N — thousands of point-to-point integrations, each repeated for every operation.
Patients were an afterthought.
The cost of that single architectural choice:
One of the most familiar sentences in American medicine remains: “We’d love to approve this — can you fax us the clinical notes?”
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.
“AI is exposing and exacerbating fundamental issues within the underlying prior authorization process … increasing billing intensity and inflating medical spending.”
“The absence of a cohesive digital and data architecture is preventing the full realization of interoperability's benefits.”
Without a shared hub, health AI cannot deliver on its promise.
Other industries solved this with a neutral utility. So can healthcare.
Visa is a neutral three-way hub connecting merchants, banks, and consumers. The routing infrastructure does not own the money or the relationship — it routes the transaction. One shared hub rather than every party building point-to-point connections to every other party.
Healthcare needs the same thing: a shared transaction routing network — with patients at the center.
From N-by-N to N-by-1. Connect once, reach everyone.
Data stays at the source. Questions go to the data. When documentation must travel for a transaction, it moves sealed between the parties that need it — not into a central record store.
We move questions and answers, not records. The network never builds or stores a database of anyone’s records.
Built so patients can see who asked about them, when, and why. This is not just faster prior authorization — it is prior authorization the patient can see.
Operated as a common utility — not a vendor’s product.
Every party connects to every other party. Thousands of point-to-point integrations.
Every party connects once.
The Hub routes — and stays payload-blind.
Washington set the deadline. Smart Health Network is the infrastructure to meet it.
The federal Interoperability and Prior Authorization rule requires health plans to support electronic, FHIR-based prior authorization, meet defined decision timeframes, and report their performance publicly — by 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 everyone, instead of building one-to-one, plan by plan.
Build on the network.
Smart Health Network runs on open standards — HL7 FHIR and X12 — 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 handles identity, authorization, and audit. Sandbox access is opening now to early builders, on synthetic data.
The Rural Health Transformation Program is the on-ramp.
States are leading because 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. The federal Rural Health Transformation Program (RHTP) put $50 billion[5] on the table and a one-year planning window — funds already designed for exactly this kind of shared infrastructure.
Delaware moved first.
It didn’t choose a vendor — it wrote shared, neutral infrastructure into its federal Rural Health Transformation plan, and named Smart Health Network in it.
“…this initiative creates comprehensive digital infrastructure connecting all rural providers, payers, hospital systems, and patients through the Smart Health Network (SHN) and the DHIN. … vendor-neutral standards will prevent vendor lock-in and stakeholder councils will ensure fair governance.”
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.
The network opens to additional states and participants in phases.
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 institutional bodies, 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 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 power, 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. Fees applied equally to all participants. Surplus is reinvested, not extracted.
These are not promises. They are architecture. Promises can be renegotiated. Architecture is what is left when promises run out.
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