Cooperative Exchange Launches Da Vinci Trebuchet Clearinghouse-to-Clearinghouse Prior Authorization Pilot


Washington, DC — [April 17, 2026]


The Cooperative Exchange, the National Clearinghouse Association, in collaboration with the HL7® Da Vinci Project, today announced the launch of the Da Vinci Trebuchet Clearinghouse-to-Clearinghouse (CH-to-CH) Prior Authorization Pilot Cohort.

The HL7 Da Vinci Project is a private-sector, industry-led initiative that uses the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard to help improve data sharing in value-based care arrangements.  One of its efforts, Da Vinci Trebuchet, runs scalable, real-world pilots focused on reducing the administrative burden of prior authorization by enabling scalable, standards-based interoperability between intermediaries or via direct connection.

The CH-to-CH pilot cohort will test how HL7® FHIR®-based prior authorization transactions can be operationalized across clearinghouse networks, extending Da Vinci prior authorization standards beyond traditional point-to-point implementations.  The pilot will also test X12 to FHIR translations between clearinghouses.

Da Vinci Trebuchet’s piloting cohort opportunity supports the Cooperative Exchange’s commitment to advancing practical, standards-based solutions through industry collaboration. By validating clearinghouse-to-clearinghouse workflows, this pilot helps lay the foundation for more automated, scalable prior authorization workflows across the healthcare ecosystem.

Pilot Objectives

  • Demonstrate interoperability between multiple clearinghouses using FHIR-based prior authorization workflows
  • Validate hybrid HL7 FHIR and X12 EDI workflows aligned to real-world operations
  • Develop a reference architecture for CH-to-CH routing, identity resolution, and endpoint discovery
  • Validate a scalable security approach for FHIR-based prior authorization
  • Help reduce provider and payer burden by enabling clearinghouses to automate prior authorization across networks

Expected Outcomes

  • A functional prototype demonstrating CH-to-CH prior authorization exchange using Da Vinci and FAST Implementation Guides and X12
  • A clearinghouse implementation playbook with technical and operational guidance
  • Identification of policy and technical barriers to CH-to-CH interoperability
  • Recommendations for future enhancements to Da Vinci, FAST, X12, and related standards and/or implementation guides


Pilot Participants








 

 

Beth Davis, Crystal Ewing and Genevieve Morris
Co-Chairs of HL7 Da Vinci Trebuchet Prior Authorization Pilot