Turn the APIs you’re already building into one shared market connection.
One connection, every market — the whole catalog as it launches.
Payers are already testing with us: the first health plan connected over launch weekend and ran prior-authorization workflows at the July 13 Delaware Connectathon — on synthetic data, through the shared network path.
The deadline and the pledge
One connection supports both the CMS-0057 readiness path and the industry pledge timeline. CMS-0057 requires FHIR-based prior authorization, defined decision timeframes, and public reporting — with API compliance dates beginning January 1, 2027 — and the nation’s major payers have publicly pledged to streamline prior authorization on the same clock.
One test path, not one per counterparty.
Without a common path, every provider, EHR, and technology partner has to establish and test separately with every payer. SHN turns that N-by-N testing problem into shared infrastructure: establish conformance through the network, then reuse that common path across authorized counterparties. New counterparties become network certification work, not another bilateral test project — the testing effort you’re already scheduling is the first place the shared path saves work.
COMPLY through shared rails for $0 in 2027.
The payer compliance utility is free through 2027 — and the exit is clean: A payer using COMPLY in 2027 may leave effective December 31, 2027 without having paid a COMPLY participation fee. Everyone can comply for free in 2027. Organizations that commit during formation preserve Launch economics for the broader utility.
COMPLY provides shared network capabilities and readiness evidence participants can use in meeting applicable requirements; participation in SHN does not by itself establish regulatory compliance.
Start with the API you already built.
The APIs you’re already building for CMS-0057 are the starting point. Instead of asking you to deploy anything new, Smart Health Network connects to what you’re already building. Starting is three things: give SHN access to your synthetic-data test endpoint, name one engineer, and choose one prior-authorization workflow to test first.
What sandbox testing does: tests your endpoint against the standardized network path · demonstrates that the tested workflow can reach your sandbox through the shared network path · catalogs implementation variance early, while it’s cheap to fix · produces readiness evidence for the January cohort.
What it doesn’t do: your compliance remains your responsibility — SHN makes the capability reachable through a shared network path · it doesn’t authorize production access · it doesn’t settle your production operating model, which is established with each launch participant.
Testing against your API is how you start. Claims, richer workflows, key custody, and operational ownership define the deeper production path.
Prior authorization isn’t the product. It’s the first transaction. The product is shared administrative rails.
The connection
Every transaction type as it launches. The CMS-0057 readiness suite — prior authorization, payer-to-payer, provider access, patient access, and related directory capabilities — in January 2027, claims and remittance in April, pharmacy prior authorization in July, quality and value-based reporting in October — and each category the catalog adds after that, on the same connection. Claims on the network is an additional, standards-based route for claims submission, claim status, attachments, and remittance — carried in the formats payers already run (X12 at the edges; the gateway handles translation). The claims operating model — routes, partner roles, and activation sequence — is being finalized with launch participants ahead of the January 13 Claims & Remittance Connectathon. See the full catalog & roadmap →
One integration, every enabled market
One network integration serves every market in which the payer and its counterparties are enabled. One connection replaces separate builds for every mandate and separate integrations with every provider — in this market and each future one where you’re enabled.
The production decision
Keep your CMS-0057 implementation. The network adds the shared distribution route into it. The gateway delegates CRD/DTR/PAS to your existing Da Vinci endpoints — you retain full UM rules and decision authority. One decision remains — who operates your Gateway: operate it yourself, have a Certified Network Partner operate it on your behalf, or use an approved managed operating model where available. Same network, same conformance requirements, same participant rights, same network participation rates.
Keep the systems you have — connect them to the shared rails. Connect directly, or through a certified partner — same network, same network participation rates. →
Enterprise architecture — multi-state payers
One enterprise agreement. State market schedules underneath it. Activation and billing occur by covered book. A payer book pays only for its highest activated service class — network participation fees never stack within a book. The covered book — not the state — is the billing unit, and different books can be in different classes.
The connection compounds — each release after prior authorization arrives on the same network relationship, never as a new integration build. How the catalog arrives →
EXPAND — the broader utility
$0.50 per member per month Standard — $0.25 Launch Participant through 2029 — covering unlimited volume across every enabled transaction type. These are EXPAND economics, not the cost of joining or complying: a payer book may remain in COMPLY indefinitely, and EXPAND is an election. New capabilities carry no additional charge, and onboarding, conformance testing, and your members’ patient access are part of ACCESS — always free. See pricing →
What it replaces
Manual transaction handling and the compliance builds themselves. Fragmented APIs are just fax machines in modern clothing — and the savings are money the market already spends. Portal and IVR operations, provider call-center volume, per-transaction clearinghouse and EDI tolls, per-provider integration projects — and each future mandate arrives as a network release instead of another vendor project. The arithmetic starts with published facts: a manual eligibility check costs $6.78 against $0.34 electronic; a manual plan-side prior authorization $3.41 against $0.05 (CAQH Index) — and the participation fee is on the order of one percent of a typical plan’s administrative spend. Whether the full catalog clears your fee is answered with your numbers, not ours: the working session builds your case from benchmark starting points that your volumes, contracts, and costs replace — and every participant sees its computed fee against displaced cost monthly.
The January capability commitment
A payer’s committed capability never waits. Production activation begins January 1 for payer capabilities that have completed agreements, credentials, conformance, and launch checks. Provider volume grows as provider cohorts activate. Provider density builds through the first quarter on funded onboarding; your compliance path never waits for it. The network makes the capability available and testable; each payer remains responsible for its own regulatory compliance, data readiness, endpoints, and operational decisions. January 1 is the launch-cohort date: production activation will begin for participants with executed agreements, production credentials, and completed readiness checks — a promotion process being finalized with launch participants ahead of January 1.
Launch Participant terms
Sign in 2026, hold the lower rate. Pay $0.25 per member per month through 2029 in each market production-certified by December 31, 2027, stepping to $0.50 on January 1, 2030. The rate locks at commitment. For payer EXPAND, billing begins at the Production Activation event for the covered book, as defined in the network participation documents. December 31, 2026 is the formation window for preserving Launch EXPAND economics. Launch Participant terms span the full published catalog. New transaction families arrive on the same connection and can be activated without another bilateral integration; activation follows the participant’s applicable service class, readiness requirements, and release process. Each release is proven at a Connectathon roughly ninety days before it ships; claims and remittance prove out at the January 13 Connectathon. Launch Participant terms cover the road, not just the on-ramp.
Per-transaction benchmarks are published third-party figures (CAQH Index; AMA survey data). Results vary by organization, starting cost, route migration, participation levels, and decommissioning timing; whether the network clears your fee is computed from your numbers in a working session, and each participant sees its own computed fee alongside displaced cost on its monthly network statement.