Preparing Health Plans for the 2027 CMS Prior Authorization Rule: An AHIP Guide
Preparing Health Plans for the 2027 CMS Prior Authorization Rule - AHIP
Summary
Health plans are required to fundamentally change how prior authorization (PA) is managed and exchanged due to the CMS Interoperability and Prior Authorization Rule, effective January 1, 2027. This webinar provides practical steps for operational transformation based on regulatory requirements and industry commitments.
Details
The CMS Interoperability and Prior Authorization Rule, effective January 1, 2027, mandates that health plans fundamentally change how prior authorization (PA) is managed, exchanged, and delivered. To enable seamless electronic workflows, the implementation of FHIR-based APIs is required. Beyond mere compliance, voluntary industry commitments set higher expectations for faster decisions, greater transparency, and reduced administrative burden. This webinar integrates these regulatory requirements with AHIP's initiatives to provide actionable steps. Attendees will learn how to operationalize key API requirements (CRD, DTR, PAS) and integrate PA into provider workflows. The goal is to reduce manual processes, increase real-time processing of approvable cases, and accelerate patient access to appropriate care. The presenters are experts in the field, providing practical insights on clinical strategy for utilization management programs and workflow efficiency using FHIR APIs. This addresses the need to move from understanding requirements to executing transformation.
Original content copyright by respective publishers