Knowledge Center

On Jan. 17, 2024, the U.S. Centers for Medicare & Medicaid Services (CMS) announced regulations aimed at speeding up the prior authorization (PA) process and promoting greater interoperability. Known as CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), there will be new requirements starting in 2026 for payers to have quicker turnaround on requests for patient care, and more data sharing among payers and physicians and other clinicians.

The announcement prompted praise from the American Academy of Family Physicians (AAFP), the Medical Group Management Association (MGMA) and WEDI, the Workgroup for Electronic Data Interchange, an organization formed in 1991 to advise the U.S. Department of Health and Human Services on technology and health information sharing. They shared responses with news outlets shortly after the CMS press release.