U.S. healthcare systems prepare for 2027 electronic prior authorization mandates

Healthcare systems are preparing for new federal interoperability requirements regarding electronic prior authorization, set to begin on January 1, 2027. Under the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule, affected payers must implement standardized APIs to allow providers to check authorization requirements, submit documentation, and receive decisions electronically.

The transition aims to replace traditional, fragmented methods such as telephone calls, faxes, and manual payer portals with a standardized framework using HL7 Fast Healthcare Interoperability Resources (FHIR) technology. This change will primarily affect Medicare Advantage organizations, Medicaid, CHIP programs, and certain Marketplace plans for medical items and services other than drugs. The American Hospital Association is coordinating with CMS and Epic to assist healthcare leaders in managing the impact on workflows and payer connectivity.