The federal government is inviting health insurance companies, hospitals and electronic health record companies to test their readiness for upcoming electronic prior authorization requirements.
The Office of the National Coordinator for Health Information Technology, the Health and Human Services Department and the Centers for Medicare and Medicaid Services announced Thursday they will hold voluntary 10-12 week testing sprints for the industry to ensure their systems are prepared for looming interoperability standards.
Beginning Jan. 1, Medicaid, Medicare and health insurance exchanges companies must use the Health Level 7 Fast Healthcare Interoperability Resources standard for processing prior authorization requests. Insurers must embed their decisions into electronic health records, and carriers must automatically send rulings to patients and providers when requested.
Carriers, technology companies and hospitals have been upgrading their technology systems since the federal government finalized the requirements in 2024.
Healthcare companies interested in testing their systems should notify ONC by Nov. 20. The federal technology research group, the Health Federally Funded Research and Development Center and the technology consulting group, the Drummond Group, will coordinate the pilots.
The agencies said they intend to use findings from industry tests to identify ways to improve electronic prior authorization standards and reduce administrative burdens.
“Federal regulations and industry standards have laid important groundwork for [electronic prior authorization], but our work is not done,” Dr. Tom Keane, national coordinator for the health information technology office, said in a news release. “With our colleagues at CMS, we are bringing partners together to advance the next phase of implementation testing to accelerate [electronic prior authorization] progress in the near term.”