CMS targeting prior authorization holdups with electronic interface testing

CMS is preparing to test a new workflow that aims to streamline the prior authorization process, reduce burdens created through non-digital workflows and rebuild trust between payors and providers. 

 

The Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface (API) test was announced in the 2026 CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule. 

 

Starting Jan. 1, 2027, participants will collaborate with electronic medical record (EMR) vendors and payors to standardize electronic prior authorization requests. CMS also notes that a new prior authorization system could help improve patient understanding of health information while reducing gaps or delays in care. 

 

For more information, visit https://www.cms.gov/priorities/electronic-prior-authorization/overview.