A shared road to January

A practical playbook for states

The same plans, providers and technology companies work across state lines. A state can help them prepare for electronic prior authorization without asking them to recreate the same implementation again.

Implement once where possible. Test once where possible. Reuse the work wherever possible.

1. Bring the market together

Name a state lead. Invite Medicaid, the insurance department, state employee health programs, commercial plans, hospital and provider associations, HIEs and existing technology partners. Include rural and Tribal providers where relevant.

Ask organizations to bring the executive or program owner and the technical person responsible for implementation. Start with a working discussion, not another general presentation.

No new SHN program budget or procurement is needed to convene that first conversation.

2. Find the work everyone is repeating

What must each organization deliver for January? Which providers can use the plan’s new capabilities? Where are registration, credentials, configuration and testing being repeated?

Choose one workflow and a real set of organizations to work through it. Identify tests already planned and agree where shared testing could replace duplicated work.

3. Join a common testing and readiness schedule

Use synthetic data to test requests, responses, missing-information steps and status. Bring the results and obstacles into the shared readiness sessions.

Keep a clear list of what works, what remains and who owns each next step. Reuse results where they cover the same requirement; keep necessary organization-specific checks.

The Road to January on Delaware’s implementation page lists the planned sessions. Organizations can join the discussion before they are ready to test.

4. Help providers put the connection to work

Use existing EHR, HIE and workflow partners. Identify practices that need configuration, training or operating assistance.

A state or other sponsor can separately consider funding defined support, including eligible transformation-program work. Specify the recipients, work, price, deliverables and ongoing costs. A temporary operating subsidy needs a renewal or transition plan.

Keep the person in the picture

For the person waiting for care, readiness means more than a working API. Can the relevant user understand whether a request was received, what is missing and who needs to act? Do staff spend less time making repeated calls?

The aim is to remove administrative work, not pass it from one organization to another or onto patients.

Preserve local authority. Share implementation.

This is a voluntary effort. States keep their laws and program authority. Plans keep their decisions and responsibilities. Providers and technology partners keep useful systems and relationships.

The shared approach does not require a single state portal or exclusive vendor for every organization. Institutions make their own participation decisions.

Start now. Put ready workflows into use.

The initial Delaware production target is January 2027, beginning with the workflows whose participating systems are ready. Testing, integration, security and operating preparation continue together.

Supported prior-authorization exchange has no SHN network or transaction fee. Other integration, vendor and operating costs may remain; any additional purchase is separately defined.

Name a lead. Bring your market. Reuse the work.

The Smart Health Network implementation in Delaware project is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $157,394,963.86 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.

State inquiries: states@smarthealthnetwork.org | A shared road to January | September 2026 guide