Healthcare Finance News April 11, 2025
Starting Jan. 1, 2026, payers must send prior authorization decisions within 7 days and expedited decisions within 72 hours.
More than half of providers and 43% of payers have yet to start work on the application programming interface requirements of the interoperability and prior authorization final rule, according to a survey by the Workgroup for Electronic Data Interchange.
The WEDI baseline survey shows many providers and payers have yet to start implementing the requirements of the Centers for Medicare and Medicaid Services’ Advancing Interoperability and Improving Prior Authorization Final Rule that goes into effect in 2026 and 2027.
One challenge for payers is sufficient funding. An estimated 35% of payers surveyed approximate the API implementation cost at between $1 million...
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