A September 18 letter from the nation's largest physician group warns that relaxing enforcement next year would leave doctors relying on faxes and phone calls while patients wait for approval of needed care.
The American Medical Association is pressing federal regulators not to soften a January 1, 2027, deadline that requires many health plans to handle prior authorization electronically. In a September 18 letter to CMS Administrator Mehmet Oz, AMA CEO John Whyte, MD, said health plans are mischaracterizing limited physician engagement as a lack of interest. That notion, he wrote, "is a manufactured problem created to justify a delay."
According to Becker's Hospital Review, the letter says some stakeholders are seeking a delay. The AMA warns that broad nonenforcement in 2027 could slow the development and testing of these systems, leaving practices dependent on faxes, phone calls, insurer portals, and repeated data entry while patients wait for care. CMS had not publicly announced any change to the deadline as of September 23.
For families, the dispute is about waiting time. A parent whose child needs an MRI, or an older adult waiting for approval for surgery or home health care, feels every day a request sits in a fax queue. The 2027 requirement is meant to let a doctor's office submit, track, and receive a decision on a request inside its own electronic record system.
A Deadline Written Into Federal Rule
CMS finalized the Interoperability and Prior Authorization rule in January 2024. According to the CMS fact sheet, certain operational requirements began January 1, 2026, and the electronic data-sharing requirements, known as application programming interfaces, generally begin January 1, 2027. Medicare Advantage organizations and state Medicaid and CHIP fee-for-service programs face the January 1 date, while Medicaid managed care plans and federal marketplace plans comply as their contract or plan years begin.
Since January 2026, Medicare Advantage plans and Medicaid and CHIP programs have had to decide urgent requests within 72 hours and standard requests within seven calendar days. All payers covered by the rule, including plans on the federal marketplace, must give a specific reason for any denial. Drug prior authorizations are excluded from the new requirements, and traditional Medicare and employer plans are not among the covered payers.
MedicalDaily previously reported that CMS fined 14 Medicare plans as the electronic deadline approached and that four health systems switched on real-time prior authorization checks inside Epic. The new development shifts the question from whether the technology is ready to whether regulators will enforce the date. Becker's reports that UnitedHealthcare, Aetna, and Network Health have already gone live with relevant tools through their work with Epic.
Delays Families Already Feel
The AMA's own survey data show why physicians are resisting any delay. In the AMA's 2025 prior authorization physician survey, which polled 1,000 physicians in December 2025 and was released in May 2026, 95% said prior authorization delays access to necessary care, and 79% said patients abandon treatment because of authorization problems. More than 1 in 4 physicians, 26%, said it had led to a serious adverse event for a patient in their care, such as hospitalization, permanent impairment, or death.
The burden is not spread evenly. Medicare Advantage enrollees, Medicaid families, and people who need imaging, specialty drugs, surgery, or care after a hospital stay face prior authorization most often. Caregivers also absorb the cost in hours spent on hold, often during a workday.
The AMA letter says physicians need clearer information from health plans and electronic health record developers, including which capabilities will be live on January 1, how office workflows will change, and how to report problems. Without that information, the Chicago-based association argues, practices cannot train staff or take part in testing.
Evidence Check on the Delay Debate
The AMA letter is an advocacy document. It does not name the groups seeking a delay, and CMS has not announced any enforcement relief. The survey figures are physician reports rather than independently verified patient outcomes, although they remain a widely cited measure of the burden.
Insurers have long argued that the system works only if both sides build their parts. When the rule was finalized in 2024, the insurer trade group AHIP said federal officials should require electronic health record vendors to build prior authorization tools so physicians can take part. Both points can be true at once: plans must build their connections, and doctors need software that uses them.
Faster electronic submission also does not guarantee approval. It changes how quickly a request moves, not the medical criteria a plan applies.
Steps for Patients Waiting on an Approval
The 72-hour and seven-day time limits already apply to Medicare Advantage, Medicaid, and CHIP, no matter how a request is sent. If care is on hold, ask the ordering office for the request's reference number and submission date. If the situation is urgent, ask whether the request was marked as expedited.
If a request is denied, the plan must give a specific reason, which is the starting point for an appeal. Medicare Advantage members can call 1-800-MEDICARE for help, and people in marketplace or Medicaid plans can contact their state insurance department or Medicaid office. Nobody should skip or delay recommended care during a pending request without talking to their clinician, especially for cancer, heart, or post-surgical care.
What happens next depends on CMS. The agency could keep the January 1 date, announce enforcement discretion, or issue more guidance. Covered plans must also keep posting annual prior authorization metrics, including approval and denial rates, which allow patients to compare plans. MedicalDaily will report any CMS decision on the 2027 deadline.
Key Questions Answered
What did the AMA ask CMS to do? In a September 18 letter, the AMA urged CMS to keep the January 1, 2027, deadline for electronic prior authorization and not to relax enforcement.
Why does the AMA call it a manufactured problem? The AMA says physicians are not uninterested in electronic prior authorization but lack support and information, and that claims of low interest are being used to justify a delay.
Which health plans must comply? Medicare Advantage, Medicaid, CHIP, and federal marketplace plans. Traditional Medicare, employer plans, and drug prior authorizations are not covered by the new requirements.
How fast must plans decide now? Medicare Advantage, Medicaid, and CHIP must decide urgent requests within 72 hours and standard requests within seven calendar days. All covered payers must give a specific reason for any denial.
Has CMS delayed the deadline? No change had been announced as of September 23.
What can I do if my approval is stuck? Ask your doctor's office for the reference number and submission date, request expedited review if the situation is urgent, and appeal any denial using the reason the plan provides.
Published by Medicaldaily.com
