Health systems join payers as early adopters of electronic prior authorization

Providers AtlantiCare, Bon Secours Mercy Health, Cleveland Clinic, Froedtert ThedaCare, Ochsner Health, Providence, Rush University System for Health, Sanford Health and Tennessee Oncology have joined payers as early adopters of the Electronic Prior Authorization Acceleration initiative by the Centers for Medicare and Medicaid Service.The health systems are joining health plans that have already signed on. The insurers include Aetna, Blue Shield of California, Cambia Health Solutions, Cigna, Elevance Health, Highmark Blue Shield, Horizon Blue Cross of Blue Shield of New Jersey, Humana and UnitedHealthcare.Electronic health record developers signing on to the initiative are athenahealth, eClinicalWorks, Epic, MEDITECH, Modernizing Medicine Inc., Oracle, TrueBridge and Networks: b.well Connected Health, CommonWell, eHealth Exchange and Kno2.In total, 30 healthcare organizations, including health systems, electronic health record developers, physician practices, networks and digital health developers, have joined payers in working with CMS to identify and address workflow, technical and operational barriers that have slowed adoption of electronic prior authorization.Together, they will determine how individual deployments function in practice across real-world workflows, CMS said. Work includes integrating electronic prior authorization into clinical and administrative systems; reducing reliance on manual processes, such as fax and portal-based workflows; increasing visibility into authorization status and decisions; and closing workflow gaps and improving technical handoffs across systems. Meaningful progress across what CMS calls the Health Tech Ecosystem requires alignment, not isolated adoption, the agency said. The organizations announced today represent an initial group of early adopters, with additional participants expected as this initiative expands. WHY THIS MATTERSCMS is advancing the Electronic Prior Authorization Acceleration efforts prior to a Jan. 1, 2027, deadline to meet the standards of the Interoperability and Prior Authorization final rule.A section of the rule that went into effect this year requires impacted payers to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests. The rule also establishes API-enabled data exchange using FHIR-based standards and public transparency by requiring impacted payers to report prior authorization metrics.THE LARGER TRENDIn April, AHIP announced the health plans that are adopting a standardized approach for electronic prior authorization requests.The standardized approach is being used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services, including CT scans and MRIs.Insurers signing on include UnitedHealthcare, Cigna, CVS Health Aetna, Elevance Health, Humana, Centene and numerous Blue Cross plans nationwide. Geisinger Health Plan and Kaiser Permanente are also part of the initiative that begins Jan. 1, 2027.Earlier this month UnitedHealthcare said it was eliminating authorization requirements for 30% of healthcare services that previously required insurer approval.ON THE RECORD"Prior authorization won't be fixed by technology alone. It requires the entire healthcare system to work together to solve real-world challenges," said CMS Administrator Dr. Mehmet Oz. "CMS continues to bring organizations together to do just that, and these early adopters are choosing to lead. This work will help reduce administrative burden, giving clinicians more time to focus on patients and helping people get care faster."Email the writer: [email protected]