Epic launched real-time prior authorization checks for clinicians at four health systems, using a new industry-standard application programming interface called Coverage Requirements Discovery.
Ochsner Health in New Orleans, Froedtert ThedaCare Health in Menomonee Falls, Wis., Denver Health and Summit Health in New Providence, N.J., went live with the tool alongside insurers UnitedHealthcare, Network Health and Aetna.
Clinicians can now see immediately whether an insurer requires prior authorization when placing an order or scheduling an appointment, according to an Aug. 17 news release from Epic.
The launch satisfies a CMS interoperability rule requiring most Medicare Advantage, Medicaid and marketplace insurers to support prior authorization APIs by Jan. 1, 2027. The participating health systems and payers went live more than five months ahead of that deadline, and 16 additional payers are in testing.
Epic, based in Verona, Wis., said the rollout supports a broader CMS push to accelerate electronic prior authorization across the healthcare industry.
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