CMS prior authorization rule updates: Is your organization prepared?

The CMS Interoperability and Prior Authorization rule changes healthcare payers, affecting Medicare Advantage, Medicaid, CHIP, and qualified health plans on federally-facilitated exchanges.

Key provisions include:

• Standard prior authorization turnaround (7 days)
• Expedited processing (72 hours)
• Mandatory reporting of measures
• New FHIR APIs for authorization
• Enhanced patient access

Implementation starts January 1, 2026, with API requirements by January 1, 2027.

Read this infographic to learn about these compliance timelines and prepare your organization.