Electronic Prior Authorization

Announcements

CMS is proposing to update the MIPS Promoting Interoperability and electronic prior authorization measures to move us forward while reducing burden. For more information, view:
- CY 2027 Medicare Physician Fee Schedule (PFS) Proposed Rule: Quality Payment Program (QPP) Fact Sheet and Policy Comparison Table
- CY 2027 PFS Proposed Rule
CMS issued a final rule to update Medicare payment policies and rates for inpatient hospitals under the Medicare hospital Inpatient Prospective Payment System (IPPS) for fiscal year FY 2027. The rule includes changes to the Electronic Prior Authorization measure for eligible hospitals and critical access hospitals. Specifically, the rule finalized the Electronic Prior Authorization measure as an optional bonus measure for CY 2027 and as a mandatory measure beginning with CY 2028.
CMS recently hosted the one-year celebration of the Health Technology Ecosystem, bringing together leaders from the government, health care, and technology sectors to feature the significant progress made over the past year in advancing interoperability, improving health data sharing, and expanding patient access to digital health tools. Read the full press release.

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The content is for health care providers. If you’re a person with Medicare, visit Medicare.gov.

Use Electronic Prior Authorization for Reduced Burden & Better Patient Care

CMS, health plans, and certified electronic health record (EHR) vendors are working together to streamline the electronic prior authorization process for medical items and services. Estimates suggest requesting prior authorizations costs providers $20–50 per hour and takes an average of 13 hours per week. For each provider, that’s approximately $34,000 and 700 hours of administrative time each year that could otherwise be used to take care of patients.

We can’t do this without you! Act now to start submitting prior authorization requests electronically in 2027.

EHR vendors can implement standardized electronic prior authorization transactions. Starting January 1, 2027, certain health plans regulated by CMS must implement and maintain these Application Programming Interfaces (APIs), so it’s important to be ready:

Patient Access API
Provider Directory API
Provider Access API
Payer-to-Payer API - View Workflow
Prior Authorization API - View Workflow

Goals

How Electronic Prior Authorization Benefits You

Act Now

Use payer-supported Prior Authorization APIs, so you can begin to experience the many benefits.

Required implementation among certain health plans regulated by CMS starts January 1, 2027, but it’s important to be prepared in advance.

Take these steps now:

Talk to your EHR vendor to confirm readiness. Ask questions to help you understand their implementation roadmap, including:
- What’s our implementation timeline?
- What are our EHR system’s API integration and electronic prior authorization capabilities?
- Is our current EHR certified to support the necessary functionality?
- What specific features are you building for:
  - Payer Prior Authorization API integration?
  - Electronic prior authorization workflows?
  - Seamless data exchange?
- Will we need to upgrade our system or purchase additional modules?
- What testing opportunities will you provide?
- What training and technical support will you offer?
- Are you participating in pilot programs with payers?
Upgrade your technology, including EHR templates and workflows, if needed. Your vendor can give you information and support.
Start testing: We strongly encourage providers to take an active role in advancing electronic prior authorization by participating in Fast Healthcare Interoperability Resources® (FHIR) API testing with your EHR vendor and payer partners. Contact your EHR vendor to learn how and when you can begin testing to make sure your systems are ready for electronic prior authorization. Early testing and collaboration between your practice, EHR vendor, and payers is essential to ensure seamless, real-world implementation of electronic prior authorization workflows. Engage now to:
- Identify gaps
- Validate workflows
- Build the technical readiness needed to meet upcoming implementation goals
- Improve the experience for your patients and staff
Testing Resources:
- Office of the National Coordinator for Health Information Technology (ONC)-supported DaVinci Inferno test kits:
- HL7 FHIR: We work with HL7 International on FHIR standards
- Workgroup for Electronic Data Interchange (WEDI): We work with this organization per a HIPAA statute
- Health Tech Ecosystem webpage
Prescription Drugs: Ask your EHR vendor if it supports electronic prior authorization for Part D prescription drugs.

Next Steps

How CMS Supports this Effort

At a June 2025 roundtable, HHS Secretary Robert F. Kennedy, Jr., CMS Administrator Dr. Mehmet Oz, and the National Coordinator for Health IT Information Technology Dr. Thomas Keane met with industry leaders to discuss their pledges to streamline the prior authorization process. Major health plans, provider organizations, and health IT stakeholders across the country joined this commitment — signaling a unified effort to drive meaningful change.

The current prior authorization process often creates unnecessary delays, places administrative burden on providers, and can stand between patients and the care they need. These challenges have contributed to frustration across the health care system and have eroded trust among patients, providers, and payers.

By coming together to address these issues, stakeholders are taking an important step toward restoring confidence in the health care system. Reducing friction, improving transparency, and streamlining workflows will enhance efficiency and help ensure that patients get timely, appropriate care.

Building trust requires accountability and collaboration. This pledge reflects a shared commitment to modernize prior authorization processes and create a more responsive, patient-centered health care experience.

Participating companies pledged to:

Standardize electronic prior authorization by using FHIR-based APIs
Reduce the volume of medical services subject to prior authorization
Honor existing authorizations during insurance transitions to ensure continuity of care
Enhance transparency and communication around authorization decisions and appeals
Expand real-time approvals to minimize delays in care for most requests by 2027
Ensure medical professionals review all clinical denials

Learn more about the pledge and our goals here: HHS Secretary Kennedy, CMS Administrator Oz Secure Industry Pledge to Fix Broken Prior Authorization System. View the Electronic Prior Authorization Pledge.

We’re committed to using other new health technologies. The Wasteful and Inappropriate Service Reduction (WISeR) Model aims to reduce wasteful and inappropriate Original Medicare spending. This model leverages enhanced technologies, such as artificial intelligence (AI) and machine learning (ML), combined with clinician review, to ensure select items and services are furnished in line with Medicare coverage criteria. It also incorporates electronic prior authorization. View more information on the WISeR model.

Electronic Prior Authorization

Use Electronic Prior Authorization for Reduced Burden & Better Patient Care

Goals

How Electronic Prior Authorization Benefits You

Act Now

Next Steps

How CMS Supports this Effort

Get More Information

Regulations & Policies

Testing

Pharmacy

Resources