As of February, a share of payers and providers had not yet started working toward the application programming interface requirements established by CMS’ interoperability and prior authorization final rule, according to survey results released March 10 by the Workgroup for Electronic Data Interchange.
WEDI advises HHS on health IT. The rule focuses on setting up data exchanges for patient information and prior authorization processes. Payers and providers must complete API requirements by Jan. 1, 2027.
The most recent survey fielded a total of 86 responses in February, with 52%, 5%, 12% and 31% representing payers, providers, clearinghouses and vendors, respectively.
Here are six takeaways from the findings:
- As of February, 10% of payers had not started work on the API requirements, down from 33% in October and 42% in the beginning of 2025. The biggest roadblocks were third parties struggling to connect systems, digitizing prior authorization protocols and having enough funding.
- Sixteen percent of payers anticipate being over 75% done with the patient access API by the Jan. 1 deadline, slightly up from the October assessment.
- Twenty-eight percent of payers estimate between $1 million and $5 million spent on API implementation, down from 42% in October. Now, 25% estimate costs to exceed $5 million, up from 15% in October.
- Out of the handful of providers to respond, one-third had not started implementation or testing, and the remaining were unsure about their progress.
- Only one-quarter of providers say they are “somewhat” or “very” likely to meet the Jan. 1 deadline, down from 47% in October and 69% at the beginning of 2025.
- Two-thirds of the surveyed providers said it is “very” or “extremely” important for the majority of contracted payers to support the prior authorization API.
