Source: ONC
Payers, providers, EHR developers and intermediaries invited are to test prior authorization workflows together ahead of 2027 requirements
The Office of the National Coordinator for Health IT (ONC) at the U.S. Department of Health and Human Services (HHS), in partnership with the Centers for Medicare & Medicaid Services (CMS), announced a series of industry testing events in production-like environments to advance end-to-end electronic prior authorization (ePA). The initiative 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.
“Federal regulations and industry standards have laid important groundwork for ePA, but our work is not done,” said Tom Keane, M.D., National Coordinator for Health IT. “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.”
Through focused, 10–12-week testing sprints, ONC, CMS and testing sprint participants will test end-to-end workflows in production-like environments to address any gaps before broader deployment. Participants will build on standards development and implementation guide testing, using production-like conditions, to identify gaps and help industry prioritize improvements and address barriers before broader implementation.
ONC and CMS intend to use the findings to quickly identify and prioritize critical improvements to standards, educational materials and implementer guidance. The goal is to support successful implementation across care settings so patients can get the care they need without avoidable administrative delays.
Testing will focus on workflows involving high-volume and high-priority clinical services using the HL7 FHIR® Da Vinci implementation guides for Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS). Scenarios and supporting resources will be coordinated for each event.
ONC and CMS have engaged 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, a virtual environment where developers, providers, payers, and intermediaries can test end-to-end interoperability with partners under production-like conditions.
Organizations interested in participating can learn more and express their interest by November 20. Participant feedback and lessons learned will inform future testing and implementation activities.
ONC and CMS encourage interest from organizations of all sizes, including smaller organizations and those serving rural communities. First-round space is limited. Watch for future announcements about additional testing opportunities. For additional information, contact Susan Hull at shull@mitre.org.
Participation in testing is voluntary. Testing activities do not constitute certification under the ONC Health IT Certification Program or a determination of compliance with CMS requirements.
More information about ONC can be found at healthit.gov, on LinkedIn, or by following @ONC_HealthIT on X.