Federal electronic prior authorization standard mandates adoption by Jan. 1, 2027

The CMS electronic prior authorization standard finalized under the Interoperability and Prior Authorization final rule becomes mandatory for all impacted payers starting January 1, 2027. This requires Medicare Advantage, Medicaid, CHIP, and Qualified Health Plan issuers on the federally-facilitated exchanges to implement a new standardized transaction for prior authorization requests, decisions, and patient data exchange. The rule aims to reduce provider burden and speed determinations, but implementation will require workflow and software updates. Practices must verify their practice management or clearinghouse vendors are ready for the transaction switch before the deadline. Test with your major payers in Q4 2026.