Healthcare Innovation January 13, 2026
Payers’ top challenges: Digitizing prior authorization policies, meeting compliance timelines; and delegated third parties facing challenges connecting with different systems
Key Highlights
- 43% of payers and 47% of providers have not yet begun their API implementation work, indicating ongoing challenges despite some progress since earlier surveys.
- Major hurdles include digitizing policies, meeting tight timelines, developing new workflows, and coordinating with third-party vendors and health plans.
- Most organizations support staggered implementation of CMS requirements and recognize the importance of education and technical training to facilitate successful adoption of FHIR APIs.
- Cost estimates for API implementation range mainly between $1 million and $5 million, with many organizations still unsure about total expenses and resource needs.
In a recent survey, 43%...
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