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Prior Authorization Takes a Leap Forward in CMS Regulation

Healthcare IT Today

I talked to Nikki Henck, Senior Director of Utilization Management at Sagility , about the implementation and potential impact of this proposed requirement, which, if finalized, will be enacted in January 2026. The release of FHIR in the mid-2010 decade changed everything. These factors are incentives for adoption.

FHIR 98
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Healthcare Analytics and Interoperability – 2023 Health IT Predictions

Healthcare IT Today

The CMS proposed ruling requires impacted payers to build and maintain a FHIR API, starting January 1st, 2026, in effort to improve the cumbersome and costly prior authorization process. This will further endeavor to cement FHIR as the data standard to support future information exchange. Clay Ritchey, CEO at Verato.