CMS and the Office of the National Coordinator for Health IT are launching a testing initiative with hospitals, EHR developers, payers and other healthcare organizations to identify gaps in electronic prior authorization workflows ahead of federal requirements taking effect in 2027.
The initiative will bring together healthcare organizations and technology developers to test electronic prior authorization processes across connected systems in production-like environments.
The agencies will conduct testing sprints lasting 10 to 12 weeks to identify technical and operational barriers before broader implementation. The effort builds on existing interoperability standards and aims to address issues that could delay patient care.
Testing will focus on high-volume and high-priority clinical services using three HL7 Fast Healthcare Interoperability Resources Da Vinci implementation guides: Coverage Requirements Discovery, Documentation Templates and Rules, and Prior Authorization Support.
ONC and CMS have enlisted the Mitre-led Health Federally Funded Research and Development Center and Drummond Group to support participant recruitment, coordination and testing. Drummond Group will operate FHIRplace, a virtual environment where healthcare organizations and technology developers can test interoperability across their systems.
The agencies plan to use findings from the initiative to identify needed improvements to technical standards, educational resources and implementation guidance.
Organizations interested in participating have until Nov. 20 to express interest. ONC and CMS are encouraging organizations of all sizes, including smaller organizations and those serving rural communities, to participate, though space in the initial round is limited.
Participation is voluntary and does not constitute certification under ONC’s Health IT Certification Program or establish compliance with CMS requirements.
