Questions, answered.
What Smart Health Network is · What it costs · Getting connected · Patients · States and launch · How this fits the wider system · Operations and reliability
What Smart Health Network is
What is Smart Health Network?
A neutral routing network that connects providers, payers, and patients through one shared hub. It starts where the pain is most urgent — prior authorization, where a routine approval that takes days can move to hours — and the same single connection carries more administrative work over time. Transactions route as sealed, encrypted messages, and the network never keeps a central copy of anyone’s records.
Where do my medical records live?
Exactly where they do today — with the doctors and insurers who hold them. The network connects those systems and routes sealed requests between them. It doesn’t build or keep a central copy of anyone’s records.
Is my data sold or used to train AI?
No. Smart Health Network never sells anyone’s data and never licenses it to train AI models. It doesn’t build a central copy of records in the first place.
A prior authorization includes clinical documentation — how is that handled?
Today that documentation travels by fax, portal upload, and mail, with less consistent protection and traceability. On the network it travels sealed, directly from the provider to the insurer that needs it. The network routes it without storing it — the hub cannot decrypt the clinical or administrative payload; it processes only the metadata required to authorize, route, and prove the exchange — and writes a status record designed for authorized patient visibility.
Are you a clearinghouse?
SHN is designed as a payload-blind routing utility, not a traditional clearinghouse. It routes sealed envelopes it cannot decrypt, takes no position in the claim or authorization, does not hold funds, and never makes money from your data. It’s the rail, not a player on it.
Who owns and controls it?
No single party — by design. Smart Health Network is operated by a mission-locked Delaware public benefit corporation, with separate bodies that set the rules, represent patients, and steward shared resources. No payer, provider, government, or acquirer can unilaterally change its rules, ownership, or purpose. The neutrality is built into the structure, not promised.
Is this only for prior authorization?
Prior authorization launches first — targeted for January 1, 2027 — because that’s where the pain and the federal deadline sit. The rest of the published catalog follows on the target release calendar, subject to launch-participant readiness and governed release approval: claims and remittance, pharmacy prior authorization, quality and value-based reporting, and new categories as the governed catalog grows — all on the same connection, at no additional charge.
What it costs
What does it cost?
Payers pay a published flat PMPM membership fee for network participation — unlimited volume across every enabled transaction type, no tiers, no negotiated deals. Providers pay no SHN connection or onboarding fee; Launch Participants pay no provider utility fee through 2028, with later fees following the published routed-claims schedule. Patient access, eligibility, public-health reporting, onboarding, and conformance testing carry no SHN network fee under the published Open Access terms. “Free” refers to SHN network fees; EHR-vendor, integrator, and internal costs remain the participant’s.
| Participant | Track | Rate |
|---|---|---|
| Payers | Launch Participant (sign by Dec 31, 2026) | $0.25 PMPM through 2029 (sign by Dec 31, 2026; certify by Dec 31, 2027 per market), then standard |
| Standard (from day one; everyone from Jan 1, 2030) | $0.50 PMPM | |
| Providers | Launch Participant (sign by Dec 31, 2026) | $0 through 2028 · 0.025% in 2029, then standard |
| Standard (from day one; everyone from Jan 1, 2030) | 0.05% of aggregate routed paid-claim volume |
Is prior authorization really free?
SHN never charges a separate transaction fee for prior authorization — permanently. Payer network participation remains subject to the published PMPM membership fee; that’s what funds the network, and we say so openly. Full participation means moving claims and remittance onto network routes as they go live in your market. In participating states, program funding separately supports provider onboarding — shown as its own line, so the subsidy never hides the price.
“You’re charging me a percentage of my paid claims?”
No. SHN charges a utility fee, and routed paid-claim volume is the usage proxy used to calculate it — measurable, auditable, and tied to the administrative workflows being replaced. SHN does not hold funds, does not take assignment, does not price on clinical content, and does not share in reimbursement. Usage is metered at your own gateway; the hub cannot decrypt the payload.
Does the Launch Participant rate lock cover only prior authorization?
No — it covers the whole catalog on the target release calendar, with each release activating in your market within 90 days of shipping (the window adjusts if a release date moves). The flat PMPM never changes with volume or transaction count.
What happens if we don’t commit by December 31, 2026?
Nothing closes. The Launch Participant window is a rate window, not a membership deadline: commit in 2026 and hold the discounted launch rates; join later and pay published standard rates, entering with your market’s next quarterly cohort. The network is open to every qualified participant, always — that’s what being a utility means.
Getting connected
Ready to test now? The two pathways, the steps, and the sandbox links are on Start Testing. How production connection works — the two decisions — is on Get Connected.
How do I join?
Start in the sandbox at no charge and see the workflow run. When you’re ready for production, you make two decisions — who hosts your gateway (you or SHN), and how your clinical system reaches it (your FHIR server, your EHR’s native API, or a SMART on FHIR app) — then complete participation agreements and conformance testing. A passing conformance result is technical readiness evidence; production activation adds executed agreements, organization-authorized production credentials, and completed launch checks.
Can we start testing without a contract?
Yes. Sandbox testing uses synthetic data only, so no negotiated participation agreement is required — standard test-environment registration and terms apply. Testing is how you start; it doesn’t obligate you to anything. Production participation is a separate, deliberate step with executed agreements, organization-authorized credentials, and completed readiness checks.
Who hosts our gateway?
Two choices. You host: a standard container in your own cloud tenancy — your keys, your logs, your monitoring — with time-boxed updates under a documented shared-responsibility model; your IT vendor or systems integrator running it is still you-hosting. SHN hosts: SHN operates the gateway as a managed service — the lightest operational burden, and typical for independent practices and smaller organizations. (Qualified platform vendors can implement the published protocol natively — an advanced path; contact SHN. Partner-hosted arrangements may become available over time. In the cloud sandbox, no gateway deployment is required at all.)
Does our EHR have to support Da Vinci natively?
No. There are three provider paths, and all terminate at the same gateway. (1) Your own FHIR server calls the gateway’s Da Vinci endpoints directly — the richest data path, and it reduces dependence on your EHR vendor’s release timeline. (2) Your EHR’s native Da Vinci API connects where the vendor supports it — the workflow stays entirely inside the EHR. (3) A SMART on FHIR app from your EHR’s marketplace — the broadest interim path for certified-EHR providers, subject to the EHR’s supported SMART capabilities and marketplace policies. Where an EHR doesn’t yet support the native workflow, the gateway constructs conformant transactions from the EHR’s standard FHIR APIs — non-conformant EHRs are supported, not excluded.
We’re a payer already building the CMS-0057 APIs. What does the network add?
Reach, not rework. Keep your CMS-0057 implementation — the network adds the shared distribution route into it: connect or authorize access to the same standards-based endpoints the rule requires, complete SHN security, conformance, and participation requirements, map your Coverage.payor identifiers, and participate in production testing. You retain full utilization-management rules and decision authority. Certify once, and every provider on the network reaches you with no pair-by-pair integration — new counterparties are network certification work, minimizing, not recreating, payer-specific onboarding.
How do we move from testing to production?
A deliberate promotion, not a rebuild: executed participation agreements, organization-authorized production credentials, security and conformance checks, a transaction capability check, and a named cohort and operating model — then burn-in where applicable. The same setup you tested carries forward.
Patients
I’m a patient — how do I use this?
There’s nothing to buy and nothing to install. The network works through your health plan, your providers, and applications you authorize. Because the network records standardized status for routed transactions, participating applications can surface submitted, received, and decided status to authorized patients as identity, payer, and application integrations are enabled — visibility begins as your state’s market goes live and those integrations activate. Everything patients touch is free of SHN network fees, permanently.
Can I see who’s asked about me?
That’s what the network is built for: routed transactions generate standardized status evidence designed for authorized patient visibility — who asked, when, and under what authority. This surfaces through participating applications as patient-facing capabilities are enabled; it is not yet available today.
When does my state get the network?
Markets launch as states and their payers commit. Delaware announced its statewide initiative July 6, 2026, launched network testing July 13, and targets the first production cohort for January 1, 2027; new markets join at each quarterly release. If you’re a patient or employer, ask your plan whether it’s on the network. If you’re a payer, provider, or state agency, use the contact route for your role.
States and launch
What can a state actually do?
Four actions. Join — a nonbinding public commitment to the launch-cohort planning process; no contract, no expenditure. Activate the Market — convene payers, providers, and implementation partners, and host a Connectathon satellite. Connect State-Sponsored Health Plans — Medicaid and the state employee plan join under the same published terms as every payer. Accelerate Provider Adoption (optional — “RHTP states”) — state-funded provider onboarding through a State Program Contract, with RHTP as the federally supported startup funding pathway. The State Playbook has the full model.
What does “January launch” actually mean?
A defined beginning, not statewide saturation. At minimum: the state or its designated participant has executed its participation agreement; designated launch payers’ endpoints are reachable; the first named provider-payer cohort can transact prior authorization in production; and a defined onboarding path exists for everyone else. Additional payers, providers, and transaction types join continuously after launch.
What if my market doesn’t have enough participants by January?
Production activation begins January 1 for payer capabilities that have completed agreements, credentials, conformance, and launch checks — provider volume then grows as provider cohorts activate on funded onboarding. For releases after January, a cohort that lacks critical mass moves to the next quarter: scheduling discipline, not failure.
Does Smart Health Network receive state funds?
Network operations are funded by published utility fees, not state program dollars. Where a state runs an RHTP-funded enablement program, enablement payments go to the certified partners who do the connection work, against verified milestones — and where SHN administers a program under a State Program Contract, its administration fee is defined, disclosed, and flat, never a percentage of the fund. The state controls its money; a state governs its program, and no state governs the network.
Who does the onboarding work?
It depends on the path: a participant can connect directly; SHN can host and configure the gateway as a managed service; Certified Network Partners — EHR vendors, HIEs, revenue-cycle firms, integrators — can do the connection work; and in participating states, program funding pays for eligible providers’ onboarding. No partner is ever required — direct connection is always available at the published rates, and certification is not an appointment. Most practices should not need to manage a bespoke integration project themselves.
Do I have to adopt every new transaction type?
Each release delivers its rails to your gateway through the published software and conformance process; activating a transaction is a governed readiness decision by your operator — never an automatic or silent update. Launch Participants commit to the published calendar as a condition of their rates. Gateways you host stay current under the network’s time-boxed update policy and shared-responsibility model.
How this fits the wider system
Does this align with federal requirements?
Yes — it’s built for them. CMS-0057 requires impacted payers to support FHIR-based prior authorization, meet defined decision timeframes, and report metrics publicly by January 1, 2027. The network is the connective layer that turns each organization’s compliance work into working, cross-sector exchange — reach, not rework. The nation’s major payers have also publicly pledged to streamline prior authorization on the same timeline; one connection supports both the mandate and the pledge. References to CMS, HHS, or CMS-0057 describe federal programs and requirements; Smart Health Network is not endorsed by CMS or HHS.
What about the next regulation?
That’s the point of shared rails: a new mandate becomes a network release, not another bespoke compliance build. The proposed drug prior-authorization rule (CMS-0062-P) is the next example — same FHIR standards, with pharmacy transactions on the network’s target calendar. (Regulatory status reviewed July 2026; reviewed quarterly.)
How does this relate to TEFCA?
TEFCA and the networks under it are building the national framework for sharing clinical records — moving a patient’s health information between the organizations that care for them. Smart Health Network handles a different layer: the administrative transactions that run alongside care — prior authorization, eligibility, claims status — which use different standards and aren’t what TEFCA was built to carry. The two are complementary; SHN adds the administrative routing the clinical-exchange framework was never designed to do.
How does this fit with my state’s health information exchange?
It complements it. State health information exchanges do important work, and Smart Health Network doesn’t replace them — they can operate certified roles on the network. Delaware is the working example: the state’s initiative builds on DHIN, the exchange Delaware already trusts, with the network extending that foundation to administrative transactions. Medicaid keeps the systems it has; a network gateway connects beside the MMIS — no core replacement.
How is this different from what already exists?
Clearinghouses and point-to-point connections solve important pieces. What’s been missing is a neutral connection point no payer or provider owns — one governed connection that reaches every enabled counterparty, with audit evidence built for patient visibility and no central record store. If today’s rails had solved this, approving routine care wouldn’t still take days of fax and phone — nine billion fax pages a year.
How does my organization become a Certified Network Partner?
Certification is earned against published criteria — a supervised first implementation, verified conformance on production-equivalent test transactions, and demonstrated continuing engineering capability — and it renews with each network release. It is a capability attestation, not an appointment: it buys no exclusivity, no routing rights, and no priority; participants always choose their own partner, and delivery revenue is the partner’s. Certification tracks include onboarding, integration, and gateway operation — the operation track maturing as partner-hosted arrangements do. Certified partners will be listed in a public registry. Tell us about your organization: partners@smarthealthnetwork.org.
Operations and reliability
What happens if my payer or provider isn’t on the network?
Nothing changes for you — today’s processes continue. The network adds a better route as both sides of your market connect; it never removes the existing ones.
What happens if the network is unavailable?
Care continues — the network falls back to today’s processes, and because it never holds anyone’s records, an outage can’t cut a patient or clinician off from their data. Participants keep their own gateways, keys, and connections, on open standards with no proprietary lock-in.
What’s available today, and what’s coming?
Available now — synthetic-data testing: the sandbox, the free CMS-0057 Readiness Check, and tested prior-authorization FHIR endpoints. Proven July 13: Delaware’s Launch & Connectathon drew more than 200 participants in person and online, with the first health plan connected to the test network and testing. Coming: the October 14 national Connectathon with state satellites, and production prior-authorization routing targeted for January 1, 2027, followed by the rest of the catalog on the target calendar. Anything not yet available is labeled as such.
Didn’t find it? Start testing → · How production connection works → · or reach the contact route for your role on the homepage.