Start with the work your state is already funding.

Bring Medicaid, its vendors and plans together with provider representatives. Identify what must work for the first prior-authorization exchange, what is being repeated, and which parts of the implementation can be shared.

Four outputs for the first working session

Map the first complete workflow. Identify the provider starting point, responsible payer service, needed information, responses and the person or team responsible for each next step.

Agree what can be reused. Compare onboarding, integration and testing plans. Reuse evidence that meets the same requirement, and preserve checks that remain organization-specific.

Plan provider adoption. Identify the EHRs, workflow partners and operating support needed by the practices the program intends to reach. Include the small and rural practices that cannot supply their own integration team.

Define the funding and operating scope. Separate common network participation from optional services and funded adoption work. Use Delaware’s materials as a starting point, then set your state’s scope, outcomes, responsibilities and approval path.

Leave the first working session with a named state lead, a selected workflow, participating implementation owners, a list of reusable work, unresolved integration needs and the next test date.

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?

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.

Timeline

Limited production for accepted medical prior-authorization workflows begins December 1, with the January 1 production milestone following for the workflows whose participating systems are ready. Testing, integration, security and operating preparation continue together.

There are no SHN participation or connection fees, and no SHN transaction fees for designated Open Access transactions. Other integration, vendor and operating costs may remain; any additional purchase is separately defined.

Required state-award acknowledgment: 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. This figure is the State of Delaware's total federal award, not funding paid to SHN. State inquiries: states@smarthealthnetwork.org | October 2026 guide