CMS Names Early Adopters for Electronic Prior Authorization Ahead of 2027 Requirements

The Centers for Medicare & Medicaid Services (CMS) is moving forward with its plan to make prior authorization more digital, connected, and easier to manage. Through its Health Tech Ecosystem, CMS has introduced the Electronic Prior Authorization Acceleration initiative to help the healthcare industry address the workflow, technical, and operational issues that continue to slow adoption.

As part of this effort, 29 healthcare organizations have joined as early adopters. The group includes health systems, EHR developers, physician practices, healthcare networks, and digital health companies. They will work alongside major national payers that have already committed to supporting CMS in improving the prior authorization process.

The initiative is focused on finding practical solutions before the 2027 requirements take effect. CMS aims to reduce manual work, improve coordination across systems, and help providers spend less time managing approvals and more time caring for patients.

CMS Administrator Dr. Mehmet Oz noted that technology alone cannot solve prior authorization challenges. He emphasized that real progress will require providers, payers, and technology partners to work together on the daily issues that affect care delivery and patient access.

This next phase of CMS’s Health Tech Ecosystem brings together organizations from different parts of the healthcare system. The early adopter group includes providers, EHR vendors, and health information networks that will help test and improve electronic prior authorization workflows before the 2027 requirements take effect.

Participating provider organizations include AtlantiCare, Bon Secours Mercy Health, Cleveland Clinic, Froedtert ThedaCare, Ochsner Health, Providence, Rush University System for Health, Sanford Health, and Tennessee Oncology.

EHR and technology participants include Athenahealth, eClinicalWorks, Epic, MEDITECH, Modernizing Medicine, Inc., Oracle, and TruBridge.

Network partners include b. Well Connected Health, CommonWell, eHealth Exchange, and Kno2.

These organizations are joining major health plans that previously signed CMS’ pledge to support prior authorization improvements. The payer group includes Aetna, Blue Shield of California, Cambia Health Solutions, Cigna, Elevance Health, Highmark Blue Shield, Horizon Blue Cross Blue Shield of New Jersey, Humana, and UnitedHealthcare.

CMS has also finalized requirements under the CMS Interoperability and Prior Authorization final rule. These rules apply to certain impacted payers and are intended to make prior authorization more electronic, transparent, and consistent.

Key requirements include:

• API-based data exchange using FHIR standards
• Clear timeframes for prior authorization decisions
• Public reporting of prior authorization performance metrics
• Industry preparation before the January 01, 2027, deadline

Along with these rulemaking efforts, the Electronic Prior Authorization Acceleration initiative is focused on the real implementation challenges that providers, payers, EHRs, and networks face in daily workflows.

The early adopters will work on making electronic prior authorization easier to use in practice, not just technically available. Their work will focus on connecting authorization tools with clinical and administrative systems, reducing dependence on faxes and payer portals, improving visibility into authorization status, and closing workflow gaps between different systems.

CMS noted that meaningful progress will require cooperation across the full healthcare ecosystem. Isolated changes by one group will not be enough to fix a process that affects providers, payers, technology vendors, and patients.

The organizations announced are part of the first early adopter group, and more participants are expected to join as the initiative expands. CMS is encouraging providers, technology companies, and network partners to take part in the effort and help build a prior authorization process that is faster, clearer, and more patient-focused.