As a Jan. 1 deadline looms for payers to adopt new prior authorization tech, Epic’s Vice President of Value-Based Care Ryan Bohochik breaks down the industry’s progress so far.

The healthcare industry is slowly but surely moving away from the old, fragmented and manual way of handling prior authorization toward a modernized electronic system.

CMS-regulated payers, such as Medicare Advantage, Medicaid and marketplace insurers, are now confronting a Jan. 1 deadline to implement the three prior authorization application programming interfaces — sets of rules that enable computer programs to communicate directly with one another — under a federal interoperability rule that was finalized in 2024.

The federal government hopes the reforms will make prior authorizations faster and more efficient. The cost-control policies, which require patients and their doctors to get approval from insurers before a service is provided, have been maligned by providers and other stakeholders for delaying patient care.

Reforming the process is a priority for the Trump administration, which has stood up multiple initiatives to improve the process through technology — and health tech companies will play a big role in making those reforms happen.

Epic, which accounts for roughly 42% of the acute care EHR market, was one of several major electronic health record companies that pledged last year to help reform prior authorization and get payers ready for the Jan. 1 deadline. By using Epic’s technology, doctors and health plans can comply with the new requirements.

Epic also plays a unique role in the implementation of the technology.

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