New integration to help health plans streamline prior authorization and prepare for CMS-0057-F compliance
SEATTLE, Sept. 10, 2026 /PRNewswire/ — MCG Health, part of the Hearst Health network and the industry’s source of truth for trusted clinical guidance, announces a newly certified integration with MHK, a leading healthcare technology provider and a sibling Hearst Health company. The new integration connects the MCG Path interoperability solution directly with the MHK CareProminence prior authorization workflow, helping health plans streamline authorization processes while supporting standards-based interoperability required by the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F).
The prior authorization process has historically required healthcare providers and health plans to navigate separate clinical, documentation, and administrative requirements. When required clinical information is not clearly identified at the point of request, submissions may be incomplete, resulting in requests for additional information, manual follow-up, longer review cycles, and ultimately, delayed care for members. Simultaneously, health plans seek to balance adapting their current utilization management workflows to the evolution of standards-based interoperability.
The new MHK CareProminence and MCG Path integration brings highly trusted clinical guidance and documentation requirements directly into the authorization workflow, connecting capabilities that have traditionally operated as separate steps. Using HL7® Da Vinci Project burden reduction standards – including Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS) – the integration surfaces evidence-based MCG clinical indications and structured documentation requirements at the point of a prior authorization request.
The integration is designed to help health plans:
- Support evidence-based decision-making by incorporating the nationally recognized MCG care guidelines into the prior authorization workflow
- Reduce administrative burden by helping providers identify and submit required clinical documentation earlier in the process
- Promote more consistent reviews by making structured clinical requirements available within existing workflows
- Advance interoperability readiness by supporting HL7 Da Vinci standards associated with CMS-0057-F API requirements that are primarily due January 1, 2027
One of the first to utilize the MHK-MCG integration will be Mountain Pacific, a multi-state nonprofit organization with a long history of innovation and healthcare quality improvement.
“We’re excited to integrate MHK CareProminence and MCG into our medical necessity review process for prior authorization as part of our continued commitment to modernizing healthcare delivery,” said Jill Alessi, Chief Executive Officer at Mountain Pacific. “By connecting trusted, nationally recognized, evidence-based clinical guidelines with clearer documentation requirements, this integration has the potential to reduce administrative burden, streamline the review process, facilitate timely care, strengthen collaboration, and support a more efficient experience for providers and their patients.”
“Prior authorization works best when clinical guidance, documentation requirements, and the authorization workflow are connected rather than operating as separate steps,” said Carol Helton, COO of MHK. “Bringing MCG’s trusted clinical guidance directly into CareProminence enables health plans to simplify that process while giving providers clearer information at the point of request. Equally important, this integration gives our customers a practical path toward the standards-based interoperability required under CMS-0057-F.”
“We’re seeing tremendous momentum for MCG Path as health plans across the country prepare for the next era of interoperable prior authorization,” said Jon Shreve, President and CEO of MCG Health. “Our partnership with MHK is a critical part of that progress, bringing the trust of MCG directly into the workflows health plans already use. Together, we’re driving more confident decisions that help patients get the right care.”
The certified MHK-MCG interoperability integration is currently available to health plans, and demonstrations can be requested via the MHK and MCG websites at mhk.com/contact/schedule-a-demo/ or mcg.com/contact-us/schedule-a-demo/.
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 mcg.com.
About MHK
MHK, formerly MedHOK, is a leading provider of healthcare SaaS solutions for health plans, pharmacy benefit managers, and provider-sponsored organizations. MHK’s platforms support utilization management, case management, population health, pharmacy management, enrollment, and compliance. Headquartered in Tampa, Fla., MHK partners with payers nationwide to optimize operations, improve outcomes, and deliver superior member experiences. For more information, visit mhk.com.
About Mountain Pacific
Established in 1973, Mountain Pacific has decades of experience collaborating with healthcare professionals, consumers and communities across multiple states to deliver innovative solutions. Through federal, state and commercial funding and partnerships, Mountain Pacific brings national public health priorities to the local level to achieve better health outcomes, lower costs, greater access to high-quality care and improved patient experiences. Learn more at mountainpacific.org.
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SOURCE MCG Health
