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.
ONC said first-round space is limited.
"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.
During the testing sprints, participants will use their own workflows to examine how prior authorization requests and decisions move across connected systems. "The focus is on finding technical barriers and workflow gaps that could arise in real-world implementation, while organizations still have an opportunity to address them before broader deployment," Hain and Prieto wrote.
ONC and CMS will use the findings from the testing events to make practical improvements. "Some findings may point to standards that need clarification or revision. Others may reveal a need for clearer educational materials for developers, providers and hospitals, or more useful implementer guidance," Hain and Prieto wrote.
"We aim to identify critical updates quickly and help industry prioritize the improvements needed for successful implementation across care settings. The purpose is to turn the progress already made through regulations and standards into workflows that reduce administrative burden and support timely care," the ONC leaders wrote.
The testing events will include workflows and real-world scenarios using the HL7 FHIR Da Vinci implementation guides for Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS). Each event will include coordinated scenarios, based off high-volume clinical services that require prior authorization and supporting resources to help participants test together, ONC said.
ONC and CMS are working with the MITRE-led Health Federally Funded Research and Development Center and Drummond Group to support stakeholder recruitment, readiness discussions, participant matching and testing coordination. Drummond Group will operate FHIRplace, the virtual environment where developers, providers, payers and intermediaries will test with their trading partners.
CMS and ONC encouraged participation from organizations of all sizes, including smaller organizations and those serving rural communities.