Cut Paperwork, Not Care.
Smart Health Network is neutral infrastructure for health transactions between providers, payers, and patients — connect once, transact with all.
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.
A neutral utility. No payer, health system, or vendor controls it. It can’t read what it routes. And the patient holds the keys.
Governed for perpetual independence and neutrality.
Delaware launched first. The network opens state by state — starting with insurance verification and prior authorization, ahead of the January 1, 2027 federal deadline.
- synthetic-data sandbox (opened July 1)
- free CMS-0057 Readiness Check
- end-to-end prior-authorization test flow
- Delaware initiative launched
- public documentation and open-source gateway artifacts
- Jan 1, 2027 — production prior authorization, eligibility, and the CMS-0057 APIs
- April 2027 — claims & remittance
- July 2027 — pharmacy
- October 2027 — quality & value-based reporting
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.
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 everyone.
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 prior authorization the patient can see.
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 everyone, 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 fee. Two simple published utility fees fund it all — and each is a small fraction of the administrative cost it replaces. See the rates →
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 on the table — and continued funding depends on showing CMS a credible plan you’re actually implementing.
Delaware moved first.
On July 6, Delaware launched the first statewide initiative of this model: 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, with a full class of payers and providers going live together. 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 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 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 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. 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 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.
Delaware Connectathon — July 13
University of Delaware · hybrid, open to all. Run the free CMS-0057 Readiness Check, then test eligibility + prior authorization live across the SHN Gateway and Hub. The same green check is your go-live gate.
Register →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