Photo: Helen King/Getty Images
LAS VEGAS – Ten percent of payers and 33% of providers have not yet started work on Prior Authorization Application Program Interface requirements, according to survey results released by the Workgroup for Electronic Data Interchange here last week at the 2026 HIMSS Global Health Conference & Exhibition.
Implementation of the API requirements is required by Jan. 1, 2027 under the Centers for Medicare and Medicaid Services Advancing Interoperability and Improving Prior Authorization Final Rule.
Results from WEDI's new survey suggest that while progress is being made, additional work is needed.
"We were encouraged to see that the percentage of payers who had not yet begun implementation declined from 43% in October 2025 to just 10% in February 2026," said WEDI Executive Director Robert Tennant.
WHY THIS MATTERS
The rule mandates the use of Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization APIs for data exchange. When implemented, these mandates are expected to deliver streamlined patient data exchange and a reduction in payer and provider burden.
Survey results show that for payers:
For the Prior Authorization API requirements, 10% have not yet started work, compared with the previous results of 33% in October 2025 and 42% in January/February 2025.
In estimating the current stage of completion with implementing the Patient Access API, 35% estimate they are 25% or less complete, down from 66% in October 2025. Sixteen percent expect to be 75% to 100% complete by Jan. 1, 2027.
The top three implementation challenges are delegated third parties facing challenges connecting with different systems, digitizing prior authorization policies, and sufficient funding.
Survey results show that for providers:
Thirty-three percent have not started implementation of the Prior Authorization API, and 67% were unsure as to the implementation and testing progress. No respondents registered any implementation progress with this round of the survey. Previously, 47% had not started implementation and testing. Less than half, 47% expect they will somewhat or very likely meet the Jan. 1, 2027, deadline.
The majority (67%) remain unsure of the total cost for implementing the requirements and training their employees.
Thirty-three percent expect the clinician to interact directly with the API Prior Authorization process at the point of care with the patient. Another 33% expect to interact with other administrative staff, and 33% were unsure.
The top three implementation challenges are sufficient internal expertise; coordinating with vendors/health plans on testing; and sorting out the various networks and how they interplay, such as TEFCA, QHIN, HIE.
Thirty-three percent of providers indicate they are somewhat or very likely to implement the Provider Access API, down from 44%.
Most providers (66%) view having the majority of their payers supporting the Prior Authorization API requirements as extremely important, up from 56%.
THE LARGER TREND
The survey questionnaire was developed by WEDI leadership and the WEDI Prior Authorization Subworkgroup. A total of 83 organizations responded to the newest survey, compared with 243 organizations in January/February 2025 and 173 in October 2025.
WEDI was formed in 1991 by then Health and Human Services Secretary Dr. Louis Sullivan to identify opportunities to improve the efficiency of health data exchanges.
ON THE RECORD
"Respondents who completed all three surveys represented a broad cross-section of the industry, including payers, providers, clearinghouses and technology vendors. WEDI plans to conduct a follow-up survey later in 2026, which will be critical for assessing the progress the industry has made in meeting these complex requirements," Tennant said. "Successful implementation will depend heavily on the industry's ability to work collectively and collaboratively."
Email the writer: SMorse@himss.org