A survey of 412 clinicians and practice leaders shows that 78% of prior authorization requests are still sent via fax, phone, or portal, and 41% are uncertain whether their EHR is prepared.
A nationwide survey of 412 ambulatory clinicians and practice leaders reveals that fewer than half are aware the federal payer API deadline is only three months away, even as most prior authorizations continue to move by fax, phone, and portal.
OmniMD, a company specializing in cloud-based EHR, practice management, and revenue cycle solutions, has published the results of its 2026 Interoperability Readiness Survey. The research assesses how ready U.S. outpatient practices are for the federal interoperability and electronic prior authorization requirements that take effect in 2027.
๐๐ก๐๐ญ ๐๐ก๐๐ง๐ ๐๐ฌ ๐ข๐ง ๐๐๐๐
โ ๐๐๐ฒ๐๐ซ ๐๐๐๐ฌ ๐ ๐จ ๐ฅ๐ข๐ฏ๐ ๐๐๐ง๐ฎ๐๐ซ๐ฒ ๐: Effective January 1, 2027, Medicare Advantage, Medicaid, CHIP payers, and Qualified Health Plan issuers on Federally-Facilitated Exchanges must have FHIR APIs in production, with the Prior Authorization API as the central component.
โ ๐๐ก๐ ๐ซ๐ฎ๐ฅ๐ ๐๐๐ก๐ข๐ง๐ ๐ข๐ญ: CMS-0057-F, the Interoperability and Prior Authorization Final Rule, was finalized in January 2024 and phases in through January 2027.
โ ๐ ๐๐ฌ๐ญ๐๐ซ ๐๐๐๐ข๐ฌ๐ข๐จ๐ง๐ฌ ๐๐ซ๐ ๐๐ฅ๐ซ๐๐๐๐ฒ ๐ซ๐๐ช๐ฎ๐ข๐ซ๐๐: Since January 1, 2026, Medicare Advantage, Medicaid, and CHIP payers must decide expedited requests within 72 hours and standard requests within 7 calendar days. Every impacted payer must provide a specific reason for any denial, regardless of how the request was submitted.
โ ๐๐๐ฒ๐๐ซ ๐๐๐ญ๐ ๐๐ญ ๐ญ๐ก๐ ๐ฉ๐จ๐ข๐ง๐ญ ๐จ๐ ๐๐๐ซ๐: The Provider Access API allows in-network providers to retrieve a patientโs claims, encounter, and prior authorization data directly from the payer, unless the patient has opted out.
โ ๐๐๐ฐ ๐๐๐ ๐๐๐ซ๐ญ๐ข๐๐ข๐๐๐ญ๐ข๐จ๐ง ๐๐ซ๐ข๐ญ๐๐ซ๐ข๐: ASTP/ONC’s HTI-4 rule adds three certification criteria for electronic prior authorization: Coverage Requirements Discovery, Documentation Templates and Rules, and Prior Authorization Support.
โ ๐ ๐ซ๐๐ฉ๐จ๐ซ๐ญ๐ข๐ง๐ ๐ฆ๐๐๐ฌ๐ฎ๐ซ๐ ๐ข๐ง ๐๐ฅ๐ฎ๐ฑ: The CY 2027 Physician Fee Schedule proposed rule would make the Electronic Prior Authorization measure optional for CY 2027, require it starting in CY 2028, and add a new measure for prescription drugs. The proposal is still awaiting finalization.
๐๐๐ฒ ๐ ๐ข๐ง๐๐ข๐ง๐ ๐ฌ
โ ๐๐๐๐๐ฅ๐ข๐ง๐ ๐๐ฐ๐๐ซ๐๐ง๐๐ฌ๐ฌ ๐ฅ๐๐ ๐ฌ ๐๐ฆ๐จ๐ง๐ ๐๐ฅ๐ข๐ง๐ข๐๐ข๐๐ง๐ฌ
โ 46 percent of respondents were aware that payers must have Prior Authorization APIs live by January 1, 2027.
โ Awareness stood at 68 percent among practice administrators and 40 percent among physicians and advanced practice providers.
โ ๐๐๐ง๐ฎ๐๐ฅ ๐ฉ๐ซ๐ข๐จ๐ซ ๐๐ฎ๐ญ๐ก๐จ๐ซ๐ข๐ณ๐๐ญ๐ข๐จ๐ง ๐ซ๐๐ฆ๐๐ข๐ง๐ฌ ๐ญ๐ก๐ ๐๐๐๐๐ฎ๐ฅ๐ญ
โ 78 percent of prior authorization requests are still submitted by fax, phone, or payer portal.
โ Practices handle a median of 24 requests per clinician each week, with staff spending a median of 11 hours per week completing and following up on them.
โ ๐๐๐ง๐๐จ๐ซ ๐ซ๐๐๐๐ข๐ง๐๐ฌ๐ฌ ๐ข๐ฌ ๐ฎ๐ง๐๐ฅ๐๐๐ซ
โ 38 percent reported that their EHR vendor has provided a timeline for HTI-4 electronic prior authorization functionality.
โ 41 percent did not know whether their current system would support the new API workflow.
โ ๐๐๐ ๐ฎ๐ฅ๐๐ญ๐จ๐ซ๐ฒ ๐ฎ๐ง๐๐๐ซ๐ญ๐๐ข๐ง๐ญ๐ฒ ๐ข๐ฌ ๐ฌ๐ก๐๐ฉ๐ข๐ง๐ ๐ฉ๐ฅ๐๐ง๐ฌ
โ 29 percent had heard of the proposal to make the measure optional in 2027.
โ Within that group, 44 percent plan to begin electronic submission in 2027 anyway, 39 percent will wait until it is required, and 17 percent are undecided.
โ ๐๐ฅ๐ข๐ง๐ข๐๐ข๐๐ง๐ฌ ๐ฌ๐๐ ๐ฏ๐๐ฅ๐ฎ๐ ๐ข๐ง ๐ฉ๐๐ฒ๐๐ซ ๐๐๐ญ๐
โ 63 percent said Provider Access API data would be useful at the point of care, particularly for patients new to the practice.
โ Their top concerns included inconsistent API readiness across payers (57 percent), staff training time (49 percent), and added EHR cost or workflow disruption (36 percent).
๐ ๐ข๐ฏ๐ ๐๐ญ๐๐ฉ๐ฌ ๐๐ซ๐๐๐ญ๐ข๐๐๐ฌ ๐๐๐ง ๐๐๐ค๐ ๐๐จ๐ฐ
โ ๐๐๐ฉ ๐ฉ๐๐ฒ๐๐ซ๐ฌ ๐ญ๐จ ๐ญ๐ก๐ ๐๐๐๐๐ฅ๐ข๐ง๐: Rank payers by prior authorization volume and identify which ones are Medicare Advantage, Medicaid managed care, CHIP, or Exchange plans covered by the January 2027 requirement.
โ ๐๐ฌ๐ค ๐ญ๐ก๐ ๐๐๐ ๐ฏ๐๐ง๐๐จ๐ซ ๐๐จ๐ซ ๐ ๐ฐ๐ซ๐ข๐ญ๐ญ๐๐ง ๐ญ๐ข๐ฆ๐๐ฅ๐ข๐ง๐: Confirm when the system will support the HTI-4 electronic prior authorization criteria and how the workflow will appear inside the chart.
โ ๐๐๐๐ข๐๐ ๐จ๐ง ๐๐๐๐ ๐ซ๐๐ฉ๐จ๐ซ๐ญ๐ข๐ง๐ ๐๐๐ซ๐ฅ๐ฒ: Once CMS finalizes the fee schedule, decide whether to submit electronically in 2027 or wait until reporting is required.
โ ๐๐จ๐๐ฎ๐ฆ๐๐ง๐ญ ๐ญ๐จ๐๐๐ฒ’๐ฌ ๐ฉ๐ซ๐ข๐จ๐ซ ๐๐ฎ๐ญ๐ก๐จ๐ซ๐ข๐ณ๐๐ญ๐ข๐จ๐ง ๐ฐ๐จ๐ซ๐ค๐๐ฅ๐จ๐ฐ: Record who submits, follows up on, and appeals each request, so staff roles can be redesigned when payer APIs come online.
โ ๐๐ซ๐๐ฉ๐๐ซ๐ ๐๐ซ๐จ๐ง๐ญ ๐๐๐ฌ๐ค ๐๐ง๐ ๐๐ฅ๐ข๐ง๐ข๐๐๐ฅ ๐ญ๐๐๐ฆ๐ฌ ๐๐จ๐ซ ๐ฉ๐๐ฒ๐๐ซ ๐๐๐ญ๐: Train staff on what Provider Access API data will show, how patient opt-outs work, and where the information fits in the visit.
๐๐จ๐ฐ ๐๐ฆ๐ง๐ข๐๐ ๐๐ฌ ๐๐๐ฅ๐ฉ๐ข๐ง๐ ๐๐ซ๐๐๐ญ๐ข๐๐๐ฌ
