MCG and Itiliti Health Form Partnership to Support Health Plans with CMS-0057-F Compliance

The new strategic alliance combines evidence-based guidance and interoperability to prepare payers for new CMS requirements

SEATTLE, Oct. 20, 2026 /PRNewswire/ -- MCG Health, part of the Hearst Health network and the industry's source of truth for trusted clinical guidance, today announced a strategic partnership with Itiliti Health to help health plans meet new federal prior authorization and interoperability requirements under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). The integrated solution combines MCG's widely trusted clinical guidance with Itiliti Health's prior authorization automation platform to streamline prior authorization workflows and support compliance ahead of CMS' January 2027 deadline.

As health plans prepare to implement CMS-0057-F, many are seeking scalable solutions to simplify compliance while reducing administrative burden for providers and members. The MCG-Itiliti Health collaboration addresses this need through a standards-based, interoperable approach that combines the MCG Path solution with Itiliti Health's Solution Suite.

"This partnership supports a more consistent, transparent, and efficient prior authorization process by providing clearer guidance to providers and reducing administrative complexity," said Bobbi Maddox, Product Manager, Pr. – Utilization Management at Blue Cross Blue Shield of Minnesota. "It also creates a stronger foundation for interoperability and real-time determinations."

MCG Path is an HL7^® FHIR^®-based application programming interface (API) solution that delivers MCG care guideline content directly within clinical workflows. Itiliti Health's platform provides policy management, prior authorization routing, automation, and interoperability capabilities designed to support payer compliance with CMS-0057-F requirements. Together, the integrated solution supports key CMS-0057-F interoperability workflows, helping health plans automate coverage requirements, documentation exchange, and prior authorization processes. The potential benefits of this integration include: 

• Faster prior authorization decisions
• Reduced provider burden
• Improved member experience
• Operational efficiency
• Lower administrative costs

MCG Health and Itiliti Health are active participants in the HL7^® Da Vinci Project, an industry initiative that helped develop the interoperability standards incorporated into CMS-0057-F. Their involvement positions both organizations to deliver solutions aligned with emerging regulatory and industry requirements.

"Health plans need more than point solutions to address the complexity of CMS-0057-F," said Michael Lunzer, President and Co-Founder of Itiliti Health. "By integrating our automation and interoperability platform with MCG's industry-leading clinical guidance, we're delivering a comprehensive solution that helps payers modernize prior authorization processes while improving transparency and efficiency across the care continuum."

"Health plans are facing increasing pressure to modernize prior authorization processes while preparing for significant regulatory change," said Gregory Dorn, MD, MPH, Interim President of MCG Health. "Our partnership with Itiliti Health brings together trusted clinical guidance and intelligent workflow automation to help payers meet CMS-0057-F requirements, reduce administrative complexity, and support faster, more transparent authorization decisions. Together, we're advancing a more connected healthcare ecosystem that benefits health plans, providers, and patients alike."

To learn more about the MCG Path solution, please visit mcg.com/solutions/payers-tpas/path-api-authorization-automation. For additional information on the Itiliti Health solutions, please visit itilitihealth.com.

About Itiliti Health

Itiliti Health is a healthcare technology company focused on prior authorization automation, medical policy digitization and interoperability for payers, including health plans, BUCA plans, TPAs, delegated vendors and state Medicaid agencies. Its solutions, including PA Checkpoint, Policy Management, Auto Auth, Clinical Decision Assistant and PA Routing, help payers reduce administrative burden, control costs and prepare for CMS-0057 compliance while preserving human clinical review on all denial decisions. For more information, visit itilitihealth.com or connect with us on LinkedIn.

About MCG Health

MCG, part of the Hearst Health network, is the trusted source of truth for clinical guidance in the healthcare industry. MCG combines evidence-based guidelines and analytics with artificial intelligence to guide efficient and accurate, evidence-based clinical decisions. MCG solutions are licensed by a vast majority of health plans, thousands of hospitals, and many state and federal government agencies to drive quality health outcomes while controlling costs. For more information, visit www.mcg.com.

About Hearst Health

The mission of Hearst Health is to guide healthcare organizations by delivering essential intelligence and software that improve the quality, safety, and efficiency of care. Hearst Health has been innovating with care for more than 40 years, with a commitment to making a lasting positive impact on health. The Hearst Health companies — FDB, Homecare Homebase, MCG, MHK, QGenda and Zynx Health — elevate care by informing and empowering participants across the health journey. To learn more, visit www.hearst.com/hearst-health and follow @Hearst Health on LinkedIn.

®HL7 and FHIR are registered trademarks of Health Level Seven International, registered with the United States Patent and Trademark Office.

SOURCE MCG Health