Smile Digital Health Partners with MCG to Advance HL7® FHIR®-Based Prior Authorization Modernization

New integration enhances automation, transparency, and compliance for payers ahead of CMS-0057-F mandate

AUSTIN, Texas, Sept. 4, 2025 /PRNewswire/ -- Smile Digital Health and MCG Health, part of the Hearst Health network, have announced a strategic partnership that integrates the nationally recognized MCG care guidelines and the MCG Path compliance solution, with Smile's robust, HL7^® FHIR^®-first Health Data Platform. Both Smile and MCG are active members of the HL7 Da Vinci Project which has been developing FHIR-based interoperability standards for prior authorization automation since 2018.

Through this unique partnership, Smile Digital Health will integrate MCG Path, a FHIR-based API (application programming interface) solution that delivers MCG care guideline content, with the Smile CMS Suite. Through the combination of these solutions, payer organizations will be able to meet the requirements of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), which is scheduled to take effect in January 2027.

Smile and MCG's powerful integration will support the three key workflows recommended under the CMS Final Rule: Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS). By incorporating MCG's widely trusted clinical content directly into Smile's platform via MCG Path's APIs, payer organizations will be able to effectively streamline clinical review processes, automate documentation, and reduce the administrative burden on both their providers and their internal teams.

 The Smile-MCG integration empowers payer organizations to:

• Simplify provider workflows with transparent, standards-based documentation requirements (including those developed by the HL7 Da Vinci Project)
• Enable faster, automated prior authorization determinations using MCG's evidence-based content
• Centralize and standardize review processes for greater operational efficiency
• Support robust CMS-0057-F compliance by embedding FHIR-based APIs directly into clinical workflows

The Smile-MCG collaboration delivers a scalable, regulation-ready solution that supports payer organizations in modernizing their infrastructure while advancing a shared vision for more interoperable, efficient, and intelligent health data exchange.

"MCG listens to its customers, and we believe this partnership will further enhance how payers and providers collaborate to support the patient," said Jon Shreve, President and CEO of MCG Health. "MCG and Smile Digital Health are leading the way in automation and interoperability, and we are supporting alignment with CMS mandates. This partnership will promote informed authorization decisions for health plan members."

"This partnership with MCG represents a pivotal step in making prior authorization faster and more transparent for payers, providers, and patients," said Duncan Weatherston, CEO of Smile Digital Health. "By embedding MCG Path's evidence-based clinical content directly into Smile's FHIR-first platform, we're helping organizations support compliance with CMS-0057-F, reduce administrative burden, and improve care delivery."

To learn more about the MCG Path solution, please visit www.mcg.com/how-we-help/health-plans/cite-evidence-based-clinical-decision-support-for-payers/mcg-path/. For additional information on the Smile Digital Health solutions, please visit: www.smiledigitalhealth.com/solution/cms.

About Smile Digital Health

Smile Digital Health is a FHIR®-first health data solutions company that provides the most advanced platform for managing and exchanging healthcare data. Smile helps healthcare organizations drive better patient outcomes, improve operational efficiency, and foster deeper collaboration across the healthcare ecosystem. Our enterprise-grade, open framework data platform drives data unification, enrichment, and elevation while ensuring compliance with industry mandates. We equip healthcare providers, payers, researchers, and life sciences organizations for a connected future beyond legacy systems, unlocking new value through the intelligent use of information, and creating #BetterGlobalHealth overall. For more information, visit SmileDigitalHealth.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 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