Four U.S. health systems have begun using a tool that instantly tells clinicians whether an insurer requires prior authorization for a treatment, replacing a process that has relied on phone calls, faxes, and internally maintained spreadsheets.
Ochsner Health, Froedtert ThedaCare Health, Denver Health, and Summit Health are the four systems now using the checks, which Epic announced Monday ahead of its annual users meeting. The checks currently work with UnitedHealthcare, CVS-owned Aetna, and Network Health, with sixteen additional payers testing the interface.
For patients, the plainest version is this. When a doctor orders a scan, procedure, or referral, the question of whether the insurance company must sign off first has often taken days to resolve. In these four systems, that specific question now answers itself while the order is being placed. What has not changed is whether the insurer says yes.
The Step That Actually Got Faster
Prior authorization has two distinct bottlenecks, and only one of them was addressed here.
The first is discovery: finding out whether a given service requires approval under a given plan. Health systems have handled this by maintaining their own lists of insurer requirements, which are laborious to keep up to date and cause delays when they fall out of date. Staff often resort to calling the insurer or logging into a separate payer portal.
The second is adjudication: the insurer reviews the clinical documentation and makes a decision. That still happens the way it always has.
The new tool uses an industry-standard interface called Coverage Requirements Discovery, built on the Fast Healthcare Interoperability Resources framework. It surfaces the payer's requirement inside the electronic record at the moment of ordering or scheduling.
The practical gain is real but narrow. Treatments that do not require prior authorization can begin immediately, rather than waiting for a check. For treatments that do, the approval process starts sooner rather than after a day of phone tag. Melissa Woods, Ochsner Health's assistant vice president of revenue cycle and financial clearance, said the change should have a visible effect on scheduling: "This will reduce administrative burden, improve efficiency, and minimize delays in patient care."
The Federal Deadline Driving the Timing
The timing traces to a federal rule rather than to industry initiative alone. A 2024 Centers for Medicare and Medicaid Services interoperability rule requires certain payers to support electronic prior authorization through standardized interfaces, with a compliance date of January 1, 2027. Affected plans include Medicare Advantage, Medicaid, and qualified health plans on the federal marketplace. The four systems went live more than five months ahead of that date.
Separate provisions of the same rule already took effect this year, shortening insurer response times to 72 hours for expedited requests and seven days for standard ones, requiring plans to give a specific reason for each denial, and requiring them to publicly report prior authorization metrics.
CMS has also assembled a group of early adopters to work through implementation barriers ahead of the deadline, spanning health plans, electronic record vendors and health systems. Froedtert, ThedaCare, and Ochsner are among the participants.
Insurers separately signed a voluntary industry pledge to answer most authorization requests in real time by 2027. That pledge carries no penalty. The CMS rule does, which is the difference physician groups have pointed to when asked why they expect this round of promises to produce more than previous ones.
The Limits That Determine Whether Patients Feel It
An automated check is only as accurate as the information the insurer supplies, and payers have a long record of trouble keeping basic data up to date. The tool queries payer systems directly rather than relying on a health system's own list, thereby removing one source of staleness and creating dependence on another.
Ryan Bohochik of Epic's product team framed the shift to Axios as an effort to "remove humans out of the prior authorization request process." That describes the request side. Knowing that authorization is required does not shorten the review, nor does it make approval more likely.
Denial rates are part of the process patients experience as harm, and they remain untouched by this deployment. The public reporting now required by the federal rule has begun producing the first comparable data on how widely denial rates vary between insurers, but that reporting measures the problem rather than changing it.
Scope is the other limit. Epic software is used by roughly 3,500 hospitals and more than 71,000 clinics, according to a review of the company's footprint, so four health systems is a very small share of even Epic's own customer base. Three payers are a small slice of the insurance market. Patients at these systems with these three insurers may experience fewer scheduling delays. Everyone else will not notice anything yet.
Options for Patients While the Rest Catches Up
The rights that apply today are not contingent on any software rollout. Patients can ask the ordering clinician's office whether prior authorization is required for a specific service and, if so, when it was submitted. If a request is denied, plans must provide the reason in writing, and patients have the right to appeal, including, in most plans, an external review by an independent reviewer.
The shortened federal timelines are worth knowing by number. For plans covered by the rule, 72 hours for expedited requests and seven days for standard ones are the current standard, and a request that has sat longer than that is worth escalating with the plan and, if needed, the state insurance department.
For urgent situations, asking the clinician's office to mark a request as expedited is the single most useful step, because it changes the clock the insurer is working against. Patients should also keep the reference number for any submitted request, since it is the fastest way to locate a file that appears to have stalled. Any decision to delay or forgo treatment while an authorization is pending should be made in consultation with the treating clinician.
What remains unknown is whether the sixteen payers now testing the interface will go live before the deadline, whether the accuracy of payer-supplied data holds up in practice, and whether faster discovery translates into measurably shorter waits for care. None of that has been demonstrated yet.
Key Questions Answered
What went live? A real-time check inside Epic's electronic health record that tells clinicians whether an insurer requires prior authorization for a service.
Which health systems and insurers? Ochsner Health, Froedtert ThedaCare Health, Denver Health, and Summit Health, with UnitedHealthcare, Aetna, and Network Health. Sixteen more players are testing.
Does this mean faster approvals? Not necessarily. It speeds up finding out whether approval is needed. The insurer's review is unchanged.
Will it reduce denials? No. Denial rates are not affected by this tool.
Why now? A 2024 CMS rule requires certain payers to support standardized electronic prior authorization by January 1, 2027.
What are the current federal response deadlines? For covered plans, 72 hours for expedited requests and seven days for standard requests.
What can I do if a request stalls? Ask the ordering office for the reference number and submission date, request expedited handling if urgent, and escalate to the plan or your state insurance department.
