Questions about joining the shared path
What is Smart Health Network?
A neutral health data network that helps plans, providers and their partners connect the systems they already use. It makes common connection and testing work reusable, beginning with prior authorization.
Why now?
January 2027 is an important point in the move to electronic prior authorization. The opportunity is to prepare together, rather than build another generation of separate connections. The Ready for January page explains the context and how to begin.
What does “connect once” mean?
Use one common connection method and reuse the identity, setup and testing work that remains valid as you reach more participants. It does not mean every system is already connected or that a new workflow never needs configuration. It means the next connection should not start from zero.
What can we do today?
Name a technical lead and run a synthetic prior authorization through a supported test environment. Synthetic data is fictitious patient information. You can also join a readiness discussion before your team is ready to test.
Do we have to replace our systems or vendors?
No. Plans keep their APIs, policies and utilization-management systems. Providers keep their EHR and workflow tools. HIEs and technology partners keep the services and relationships that work. The new connection builds on those investments.
What does prior authorization cost on SHN?
Within its supported scope and operating limits, there is no SHN participation, network-access, transaction or required Gateway-software-license fee. Required status and records are included. What’s Included lists the six no-fee use cases and explains optional services and other implementation costs.
How does SHN sustain the network?
Through separately funded implementation work and optional operating and software services. An organization can buy additional help without every participant having to buy the same service. SHN does not earn independent rights to sell patient information through participation or hosting.
Who runs the Gateway?
Your own team, a qualified independent operator or SHN through its optional Managed Gateway service. SHN remains accountable for the operating service it sells. Your operator choice does not change your network rights.
Who makes the coverage decision?
The health plan. SHN carries requests, responses and status; it does not decide medical necessity or coverage. Providers remain responsible for clinical decisions.
How will people see progress?
The aim is to make a request’s status understandable through connected provider, plan or partner applications: what was submitted, what is missing, who needs to act and whether a decision was made. Patient and caregiver access is enabled with the relevant organizations and permissions. The public website is not a place to check a real request.
How is information protected?
The routing Hub is designed to carry encrypted healthcare messages without the keys to read them. Authorized systems handle the information needed for the work. Rules and service terms limit access, retention and use. Hosting or participation does not permit independent resale, unrelated model training or disclosure of a participant’s identifiable performance to competitors.
Who looks after the public interest?
The governance framework combines a public-benefit operator, a Governance Council safeguarding neutrality, an independent Data Rights Trust protecting patients, and a Participant Advisory Council bringing experience from providers, plans and builders. See Governance for how these roles fit together.
Can the no-fee offer change without our knowledge?
More connections and the end of startup funding do not automatically create a charge. Changes to Open Access designations require Governance Council approval and the applicable notice and participant protections. An included step cannot become paid just because it is renamed.
Does a state have to buy a program first?
No. A state can convene its market and join shared learning without a new SHN procurement or program budget. Organizations make their own participation decisions. A separately funded implementation program is another choice.
Does testing commit us to production?
No. Test-environment terms apply, but a synthetic test is not a production purchase or approval. Before carrying live traffic, the parties complete the agreements and technical, security and operating checks for the actual connection.
Does participation establish regulatory compliance?
No. It supports implementation and produces evidence about the functions tested. Plans retain their regulatory responsibilities; SHN testing is not CMS certification. Detailed regulatory context is on Ready for January.
What happens if a service fails or we stop using it?
The production terms specify support, incident communication, recovery and transition. SHN is responsible for its own service obligations. Ending an optional purchase does not erase included rights or required records. Changing Gateway operators needs a handover plan for unfinished requests and later updates, not just an export of old records.
Is prior authorization the whole plan?
No. The common connection is intended to support more use cases and useful work across organizations over time. New capabilities will have their own scope and availability. The immediate invitation is to test prior authorization and help make the shared approach work.