CMS Announces Electronic Prior Authorization Policy Update

Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz, M.D., announced the next phases in the agency’s pledge with major health plans to streamline and improve the prior authorization process.

In the May 5 announcement, Oz said CMS will add electronic prior authorization to the Health Tech Ecosystem, allowing health systems, hospitals, physician practices, electronic health record (EHR) vendors, and digital health developers to join payers in modernizing the process.

“Committed working groups across these stakeholders will align on CMS Interoperability and Prior Authorization Final Rule deadlines, addressing workflow gaps and technical handoffs that no single sector can fix alone,” Oz said. “Prior authorization touches every part of the health care system; now, every part has a seat at the table.”

Additionally, CMS has been collaborating with EHR vendors to streamline and digitize the prior authorization process for medical items and services. Starting Jan. 1, 2026, impacted payers across Medicare Advantage, Medicaid, Children’s Health Insurance Program, and Marketplace (federally facilitated exchange) plans are now required to send prior authorization decision requests for medical items and services within 72 hours for expedited or urgent requests and seven calendar days for standard or nonurgent requests.

Electronic prior authorization interfaces from payers will go live on Jan. 1, 2027.

Source: https://www.cms.gov/newsroom/blog/moving-prior-authorization-21st-century