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HL7 CodeX pilot program 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 Rapid Care Interoperability Resources, or FHIR.


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

HL7 CodeX projects focus on use cases that address cancer care interoperability by implementing the FHIR Standard Minimum Common Oncology Data Elements, or mCODE, which defines critical cancer characteristics in an interoperable framework.

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

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

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

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

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


Payer preauthorization processes are often based on manual inspection, with no automation or standard health system interface.

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

Laying the groundwork for what interoperability is expected to look like, recent mandates: the The Patient Access and Interoperability Final Rule of 2020 and the 21st Century Cures Act accelerate the speed of delivery, through a secure API, that turns data into digestible information for patient profiles.

When HL7 came out with FHIR, it opened up opportunities for Obtain high-quality computable data. Implementing out-of-the-box programming APIs for healthcare interoperability is considered less risky and easy.

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


“We’re teaming up with 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,” said Eric Gratias, MD, oncologist and chief marketing officer of eviCore, at the Evernorth company, in a prepared statement.

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

Andrea Fox is a senior editor for Healthcare IT News.

Healthcare IT News is published by HIMSS.


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