The Centers for Medicare & Medicaid services (CMS) has officially added electronic prior authorization capabilities to its Health Tech Ecosystem.
In addition, according to CMS, important institutions - including health systems, hospitals, physician practices, electronic health record (EHR) vendors, and digital health developers - are joining payers to improve the electronic prior authorization initiative.
HME News highlights two prominent actions being taken:
- Committed working groups across these stakeholders will align on Interoperability and Prior Authorization Final Rule deadlines, addressing workflow gaps and technical handoffs.
- The agency has also been working with EHR vendors to streamline and digitize the prior authorization process for medical items and services. As of Jan. 1, 2026, impacted payers across Medicare Advantage, CHIP and Marketplace plans are required to send prior authorization decisions for medical items and services within 72 hours for expedited requests and seven calendar days for standard requests. Electronic prior authorization interfaces from these payers will go live Jan. 1, 2027.
CMS administrator Dr. Mehmet Oz states:
“CMS has engaged extensively with the health tech community, working with vendors to embed electronic prior authorization directly into EHRs, and with health IT developers to ensure that implementation guides reflect real-world workflows. This ecosystem-wide coordination is what separates this effort from previous attempts at prior authorization reform. When data flows seamlessly -- between a provider’s EHR, the payer’s electronic prior authorization interfaces, and a patient’s health record -- the entire system becomes more responsive, more accountable, and more focused on what matters most: getting patients the care they need without unnecessary delays or burdens.”
Interested in diving deeper? Health care providers can explore CMS’ dedicated Electronic Prior Authorization webpage.
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