The American Medical Association (AMA) announced Tuesday a new interoperability initiative aimed at supporting electronic prior authorizations by better connecting clinical terminology to its Current Procedural Terminology (CPT) administrative coding.
The professional association said Tuesday it will be developing and deploying SNOMED CT— a structured set of descriptive terms that serve as a shared medical vocabulary for computer systems—to CPT terminology mappings. Doing so will ultimately create a foundation for “scalable automation” to streamline workflows, improve data exchange and foster more efficient and quicker prior authorization outcomes, AMA said.
Moreover, it aligns with the upcoming Jan. 1, 2027 Centers for Medicare & Medicaid Services (CMS) FHIR-based prior authorization compliance deadline.
The initiative will begin by targeting prior authorization cases that have the “greatest potential” to reduce administrative burden and aid patients in receiving timely care, the organization said. AMA plans to work with key stakeholders, like health plans and health IT developers, to test and refine mappings.
The organization will also organize technical working sessions, pilots, educational forums and more in the coming months for stakeholders to participate in.
“Modernizing prior authorization requires more than electronic bridges between software applications,” said Willie Underwood III, M.D., AMA president, in a statement. “It requires trusted, interoperable terminology assets that can support real-world clinical and administrative workflows. By helping bridge SNOMED CT clinical concepts and CPT procedural coding for prior authorization use cases, the AMA aims to support a more seamless, standards-based ecosystem for physicians, hospitals, payers and patients.”
The announcement comes shortly after AMA's Annual Meeting of the House of Delegates, where a slew of other new policies were introduced by the country's largest physician body.
Among the policies voted on by members includes urging exemptions for upcoming Medicaid work requirements, new public health stances, additional safeguards for artificial intelligence use by health plans and more.