Clinicians at Ochsner Health, Froedtert ThedaCare Health, Denver Health, and Summit Health will now know right away whether a health insurer’s authorization is needed prior to providing treatment. Previously, health systems had to rely on their own lists of insurer requirements—lists that are time-consuming to maintain and can cause delays when they become out of date. With this information available in real time, treatments that do not need prior authorization can begin immediately, and for those that do, the approval process can start sooner.
Epic is helping providers throughout the country implement real-time prior authorization checks with United Healthcare, Network Health, Aetna, and other health insurers using a new industry-standard API called Coverage Requirements Discovery (CRD). Clinicians and staff can easily check prior authorization requirements in Epic when placing an order or before scheduling an appointment, eliminating the need for phone calls, faxes, or retyping information into separate insurance portals.
“At Ochsner Health, we’re excited to implement the Prior Authorization API, which transforms a traditionally manual, time-consuming process into a streamlined experience for our care teams. This will reduce administrative burden, improve efficiency, and minimize delays in patient care,” said Melissa Woods, Ochsner Health’s assistant vice president of revenue cycle and financial clearance.
CRD satisfies a key requirement of a new federal interoperability rule that will require most Medicare Advantage, Medicaid, and marketplace insurers to support prior authorization APIs—software connections that let distinct systems exchange information directly—by January 1, 2027. Ochsner Health, Froedtert ThedaCare Health, Denver Health, Summit Health, UnitedHealthcare, Network Health, and Aetna went live more than five months ahead of that deadline. There are sixteen more payers in testing.
“At Froedtert ThedaCare, we strive to be the trusted health partner with the communities we serve. That means making access to care easier, faster and more affordable,” said Imran Andrabi, MD, president and CEO of Froedtert ThedaCare. “Partnering with Epic, Network Health and others to launch real-time prior authorization helps our patients and teams focus on the care that’s needed.”
This work helps to address a CMS priority to accelerate electronic prior authorization across the industry.
