CMS announces electronic prior authorization initiative

The Centers for Medicare & Medicaid Services yesterday announced a new electronic prior authorization initiative as part of its Health Technology Ecosystem. CMS Administrator Mehmet Oz, M.D., said that working groups across pledge categories will align on CMS’ interoperability and prior authorization final rule deadlines, working to address workflow gaps and technical handoffs. Electronic prior authorization interfaces for impacted payers are mandated to go live across Medicare Advantage, Medicaid, Children’s Health Insurance Program and Health Insurance Marketplace plans on Jan. 1, 2027. The initiative follows last year’s Department of Health and Human Services announcement of health insurers pledging to streamline prior authorization processes across their lines of business.