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ONC, CMS move electronic prior authorization into real-world testing

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ONC, CMS move electronic prior authorization into real-world testing

The Office of the National Coordinator for Health IT (ONC) is launching a voluntary industry testing initiative to help healthcare organizations prepare for federal electronic prior authorization requirements taking effect in 2027.

ONC is collaborating with the Centers for Medicare and Medicaid Services (CMS) to launch a series of industry testing events in production-like environments to advance end-to-end electronic prior authorization (ePA), the agencies announced Thursday.

A federal rule requires some payers to implement an application programming interface (API) to support electronic prior authorization processes by January 1. Impacted payers include Medicare Advantage, Medicaid managed care, CHIP and ACA exchange plans.

The focused, 10- to 12-week testing sprints will bring together payers, providers, hospitals, electronic health record (EHR) developers, intermediaries and other industry partners to test their own workflows across connected systems and identify gaps before broader implementation, CMS and ONC officials said.

"Federal regulations and industry standards have laid important groundwork for ePA, but our work is not done," Tom Keane, M.D., National Coordinator for Health IT, said in a statement. "With our colleagues at CMS, we are bringing partners together to advance the next phase of implementation testing to accelerate ePA progress in the near term."

Organizations interested in participating can learn more and sign up for the initiative by November 20, according to ONC. Participant feedback and lessons learned will inform future testing and implementation activities.

"Regulations and industry standards have laid important groundwork for ePA but real work remains to put this policy into practice. These events mark the next phase of implementation testing, bringing trading partners together to examine end-to-end workflows in production-like environments," ONC leaders Ashley Hain and Molly Prieto, principal deputy director of the Office of Standards, Certification and Analysis, wrote in a blog post.


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