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WEDI Survey Finds Payers and Providers Facing Significant Challenges in Meeting CMS Interoperability and Prior Authorization Requirements

Lack of Financial Resources, Determining a Cohesive Enterprise Strategy Cited as Top Implementation Concerns

WASHINGTON, DC, April 9, 2025 — The Workgroup for Electronic Data Interchange (WEDI) released results of its baseline survey conducted earlier this year on the industry’s readiness to meet requirements of the Centers for Medicare & Medicaid Services (CMS) Advancing Interoperability and Improving Prior Authorization Final Rule, also known as CMS-0057-F. This rule mandates several new provisions to increase data sharing, including Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization Application Programming Interfaces (APIs). These new data sharing provisions have the potential for much-needed reduction in overall payer, provider, and patient burden by streamlining prior authorization and improving patient data exchange. Impacted entities are required to implement the API requirements by January 1, 2027. The rule also requires covered payers to publicly report designated prior authorization metrics by January 1, 2026.

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