HL7 CodeX pilot to test prior authorizations in oncology

Evernorth, the health services arm of Cigna, and Varian, part of Siemens Healthineers, are partnering to improve data standardization and interoperability in oncology using Health Level Seven International’s Fast Healthcare Interoperability Resources, or FHIR.


To reduce costs and get patients into the radiation treatment they need faster, the CodeX collaborators are focusing on health system-to-payer interactions. 

HL7’s CodeX projects center on use cases that address cancer care interoperability by implementing the FHIR standard minimal Common Oncology Data Elements, or mCODE, which defines the critical cancer characteristics in an interoperable framework. 

Phase one of this CodeX oncology pilot will build and test the exchange of prior authorization information between payer and provider systems through automation and standardization using breast and prostate cancer patients’ electronic health records.

Once the exchanges are successful, phase two of the pilot will test mCODE-enabled prior authorization workflows in real-world settings.

The pilot requires the partners to define, model and scale an automated process to extract and exchange the necessary information to expedite the prior authorization approvals for cancer patients and reduce burdens on providers and payers. 

The American Society for Radiation Oncology, the Oncology Nursing Society, MCG Health, Mettle Solutions, Oncora Medical, Navigate Oncology and Telligen are working with Evernorth and Varian on the pilot, and practices within the U.S. Oncology Network will be the first to test the mCODE-enabled automation. 

Pilot results will inform providers and payers on how to apply the process to their workflows to reduce administrative burdens and to get patients faster access to treatment that can improve their outcomes.


Payer prior authorization processes often rely on manual inspection, with no automation or standard health system interface. 

But no single organization can solve the endemic challenges of information sharing that requires extracting complex data from one system and inserting it into another system that uses a different database schema and a different user interface in order to get accurate and fast results.

Laying the groundwork for how interoperability is expected to look, recent mandates – the 2020  Interoperability and Patient Access final rule and The 21st Century Cures Act – hasten the speed of delivery, via secure API, that converts data into digestible information for patient profiles.

When HL7 came out with FHIR, it opened opportunities to obtain high-quality, computable data. Implementing off-the-shelf programming APIs for healthcare interoperability is considered less risky and easy. 

By integrating the standard mCODE language, CodeX projects like this one to enable prior authorization auto-approvals can support better, safer and faster cancer care delivery, according to the Prior Authorization in Oncology page on the publicly-available online CodeX team workspace.


“We joined CodeX to help drive better communication across the healthcare ecosystem and continue to optimize prior authorization to meet the needs of providers, patients and payers,” Dr. Eric Gratias, an oncologist and CMO eviCore, an Evernorth company, said in a prepared statement.

“As a cancer care company, one of our main focuses is on finding ways to accelerate the path from diagnosis to treatment,” added Ashley Smith, vice president of oncology information systems and Noona at Varian.

Andrea Fox is senior editor of Healthcare IT News.
Email: [email protected]

Healthcare IT News is a HIMSS publication.

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