As Point32Health upgrades our secure provider portal experience through Availity EssentialsTM (see related article in this issue), we are also preparing for new interoperability capabilities that will give providers more connected ways to access certain payer-held information, support care coordination, and complete some administrative tasks more efficiently.
Together, these efforts reflect our broader commitment to giving providers practical, secure options for working with us — whether through our secure portals, electronic data interchange (EDI), or other channels.
About interoperability
Interoperability refers to the electronic exchange of health information across different systems, organizations, and technology platforms. In practice, it may allow providers to access important patient information more directly through the systems they already use, rather than relying on phone calls, faxes, or other manual processes.
These capabilities support secure, standards-based data exchange and align with federal requirements intended to reduce administrative burden, improve care coordination, and streamline prior authorization workflows.
Federal interoperability requirements phase in over time, with key API requirements for Medicare, Medicaid, and Duals generally beginning Jan. 1, 2027. Point32Health also plans to make electronic prior authorization (ePA) application programming interface (API) functionality available for Commercial plans, with implementation occurring in 2027. Because implementation will be phased, available functionality, access methods, and timing may vary by product, provider organization, and system capabilities.
Patient information exchange capabilities
Point32Health is preparing for new data exchange capabilities that will allow authorized in-network providers with an established treatment relationship to request certain patient information through a Provider Access API. A Provider Access API is a secure technology connection that allows authorized systems to request and exchange information using common standards.
Through this capability, providers may be able to access payer-held information, such as claims, encounter data, and certain clinical information, to support treatment and care coordination. For providers, this means some information that currently requires a portal search, phone call, fax, or separate request may eventually be available through a more connected electronic workflow.
How providers will access information
Because one size does not fit all, Point32Health expects to support multiple ways for providers to connect to or access information. Larger provider organizations may connect through their electronic health record or electronic medical record system, such as Epic or another EHR platform. Other providers may access tools through established channels such as NEHEN or the Point32Health secure provider portals.
Providers who use the Provider Access API will need to complete a registration process before access is granted. More information about registration, including where and how to register, will be shared as implementation details are finalized.
Interoperability and electronic prior authorization
Interoperability will also support electronic prior authorization capabilities with ePA available for Tufts Health Plan products by Jan. 1, 2027 and then expanding to Harvard Pilgrim Health Care Commercial later in 2027. These tools are intended to make it easier for providers to determine whether a service requires prior authorization, submit certain medical prior authorization requests and supporting documentation electronically, and track authorization status through a more connected workflow.
For providers using compatible systems, this may allow prior authorization activity to occur within their existing EHR workflow.
While ePA offers another option for providers, existing options, such as the Point32Health secure provider portals and fax, remain available.
Next steps and more information
Additional information about registration, access options, and implementation timing will be shared in future issues.