CMS-0057-F is accelerating the shift to electronic prior authorization, but implementing a compliant Prior Authorization API is only the beginning. Health plans must also deliver a reliable, accessible experience that providers will use in their everyday workflows.
In this on-demand webinar, Steven Berkow of InterSystems and Robert Tennant of WEDI share findings from approximately 150 payer, provider, policy, and technology stakeholders on the capabilities needed to drive widespread provider adoption.
Watch the webinar to learn:
- Why health plans should look beyond regulatory compliance
- How EHR integration can improve provider adoption
- What providers expect from response speed, reliability, and consistency
- How to prioritize lines of business and covered services
- Why a soft launch can reduce implementation risk
Key Findings for Health Plans
Provider adoption depends on whether electronic prior authorization makes existing processes easier and more reliable. The stakeholder findings suggest that health plans should:
- Offer consistent workflows across major lines of business
- Help providers retrieve and populate required clinical information
- Deliver usable and consistent responses at least 90% of the time
- Make electronic prior authorization accessible through EHR workflows
- Test the experience with selected providers before broader deployment
Speakers
- Steven Berkow, Head of Value-Based Care Market Strategy, InterSystems
- Robert Tennant, Executive Director, WEDI
Frequently Asked Questions
What is electronic prior authorization?
Electronic prior authorization, or ePA, uses digital workflows to identify requirements, exchange documentation, submit authorization requests, and return payer decisions.
What does CMS-0057-F require?
Beginning January 1, 2027, impacted payers must maintain a Prior Authorization API for covered medical items and services, excluding drugs. The API must support requirements discovery, documentation exchange, request submission, and payer responses.
How can health plans encourage provider adoption?
Health plans can improve adoption by integrating electronic prior authorization into EHR workflows, reducing manual information retrieval, delivering reliable responses, and supporting consistent processes across lines of business.
Why should health plans consider a soft launch?
A soft launch allows health plans to test workflows with selected providers, resolve technical and operational issues, and improve the experience before promoting electronic prior authorization across the broader network.