ONC and CMS launch real-world testing for electronic prior authorization ahead of 2027 deadline

The feds are stress-testing prior auth before it goes live.

ONC and CMS are teaming up to launch a series of voluntary industry testing events designed to get healthcare organizations ready for federal electronic prior authorization (ePA) requirements kicking in on January 1, 2027. The initiative targets impacted payers — including Medicare Advantage, Medicaid managed care, CHIP, and ACA exchange plans — and brings together providers, hospitals, EHR developers, and intermediaries to test end-to-end workflows in realistic environments before the rules go into effect.

The 10- to 12-week testing sprints will use HL7 FHIR Da Vinci implementation guides and focus on high-volume clinical services that commonly require prior authorization. The goal: uncover technical gaps and workflow bottlenecks while there's still time to fix them. Organizations of all sizes — including smaller and rural ones — are encouraged to participate. Sign-ups close November 20.

Key Takeaways:

• Testing events will simulate real-world prior auth workflows across payers, providers, and EHR systems
• Findings may trigger updates to standards, developer guidance, or educational materials
• MITRE's Health FFRDC and Drummond Group are supporting coordination and operating the virtual testing environment (FHIRplace)

Why it matters: Prior authorization is one of healthcare's biggest administrative headaches. Getting ePA right before the 2027 mandate could meaningfully cut delays in patient care and reduce the paperwork burden on clinicians and staff.