Blog | 7/15/2025

Prior Authorization Gets “Pretty Please” from CMS

By Jeff Abraham and Greg Chittim

The prior authorization (PA) process—long notorious for delaying care and draining provider resources—is finally undergoing a digital transformation. In June 2025, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) secured an industry-wide commitment to streamline PA across Medicare Advantage, Medicaid Managed Care, and commercial plans.

The pledge outlines six major reforms, including standardized electronic submissions using FHIR APIs, reducing the number of services requiring PA, and expanding real-time approvals by 2027. The goal: cut red tape, speed up decision timelines, and rebuild trust in the system. “These commitments represent a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care,” said CMS Administrator Dr. Mehmet Oz.

While many payers still rely on fragmented manual workflows, momentum is building—especially among Medicare and Medicaid plans under pressure from faster regulatory timelines. Companies like Availity, Cohere Health, and Verata Health (now part of Olive AI) are driving innovation by automating clinical review, enabling real-time determinations, and integrating decision support directly into provider workflows.

As CMS pushes toward fully interoperable, automated PA systems, technology vendors with scalable solutions are well-positioned to lead. The challenge now: translating policy momentum into operational execution before 2027.