CMS taps 30 healthcare organizations for prior authorization initiative

 The Centers for Medicare & Medicaid Services is launching a new initiative aimed at accelerating adoption of electronic prior authorization tools ahead of federal requirements set to take effect in 2027.

CMS said May 13 that 30 healthcare organizations, including health systems, EHR developers, physician practices, networks and digital health developers, have joined its Electronic Prior Authorization Acceleration initiative as early adopters, according to a news release.

The initiative is part of CMS’ broader Health Tech Ecosystem effort and is designed to address workflow, technical and operational challenges that have slowed adoption of electronic prior authorization across the healthcare system.

Health systems and provider organizations participating as early adopters include Cleveland Clinic, Providence in Renton, Wash., Ochsner Health in New Orleans, Rush University System for Health in Chicago and Sanford Health in Sioux Falls, S.D., among others. EHR companies joining the effort include Epic, Oracle, Athenahealth and Meditech.

The organizations join several health plans that previously signed a CMS pledge related to prior authorization modernization last year, including Aetna, Cigna, Humana and UnitedHealthcare, according to the release.

CMS said the initiative is intended to help healthcare organizations prepare for requirements established under the agency’s Interoperability and Prior Authorization final rule, which takes effect Jan. 1, 2027. The rule requires certain payers to support electronic prior authorization for medical items and services through API-enabled data exchange using FHIR-based standards, defined decision timeframes and public reporting of prior authorization metrics.

According to the release, participating organizations in the acceleration initiative will work to integrate electronic prior authorization into clinical and administrative systems, reduce reliance on manual processes such as fax-based workflows, increase visibility into authorization status and improve technical handoffs across systems.

CMS said additional organizations are expected to join the initiative as it expands.

https://www.beckershospitalreview.com/healthcare-information-technology/cms-taps-29-healthcare-organizations-for-prior-authorization-initiative/