Cut Paperwork, Not Care.
Keep the systems and standards-based APIs you already use. Add one shared network connection that makes them reachable across the market — connect once, reach every enabled, authorized participant.
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 cannot decrypt what it routes. And the patient holds the keys.
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, ahead of the January 1, 2027 federal deadline.
Synthetic-data testing is open now. Production prior-authorization routing is targeted for January 1, 2027 for participants completing agreements, credentials, and readiness checks.
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 →- 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
- April 2027 — claims & remittance
- July 2027 — pharmacy prior authorization
- October 2027 — quality & value-based reporting
Target release calendar, subject to launch-participant readiness and governed release approval.
Start simple. Deepen over time.
Payers begin on the sandbox APIs they’re already building for CMS-0057, then choose their hosting path — a gateway they host or SHN hosts. 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.
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.
Patients were an afterthought. Here’s the bill:
One of the most familiar sentences in American medicine remains: “We’d love to approve this — can you fax us the clinical notes?”
Other industries solved this with a neutral utility. So can healthcare. See how it works →
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.
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, reach every enabled, authorized counterparty.
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 who asked about them, 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.
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.”
The answer isn’t less AI — it’s AI on shared rails. On a neutral network with verified identity and structured data, the same agents that today escalate the arms race become useful: drafting cleaner requests, answering them faster, with every exchange auditable. Fix the structure, and the machines work for everyone.
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 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. 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.
Much of the network is free — permanently.
Patient access, eligibility, public-health reporting, onboarding, and conformance testing never carry a separate charge. Two simple published utility fees fund it all — a flat payer PMPM and a provider routed-claims fee — and each is a small fraction of the administrative cost it replaces. See the rates →
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. The 2026 Launch Participant window closes December 31.
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 Smart Health 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 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. The same published utility fees apply to every 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 rates. →
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