Payers still have a ways to go in meeting their goals ahead of CMS’ Advancing Interoperability and Improving Prior Authorization Final Rule, according to a survey from the Workgroup for Electronic Data Interchange.
WEDI advises HHS on health IT. CMS’ final rule will require insurers to implement an application programming interface and report prior authorization metrics. The workgroup gathered insights from payers in October, which followed a survey from earlier this year, to better understand progress toward compliance.
Here are five things to know from the payer survey:
1. One-third of payers have not started their application programming interface requirements, down from 42% in the previous survey.
2. Top payer challenges included digitizing prior authorization policies, following compliance timelines and third-parties struggling with connecting different systems. Concerns over prior authorization were also a top issue in the earlier survey.
3. More payers — 45% — will not include drugs in the prior authorization API, up from 26.5% previously.
4. A growing percentage of payers — now 42% — estimate a $1 million to $5 million incremental cost to execute the prior authorization API elements.
5. One-third of payers estimate 25% completion of incremental requirements by the Jan. 1, 2027, deadline, and another one-third estimate zero percent completion.
