Epic, Oracle join CMS prior-auth initiative

CMS said on May 13 that 29 healthcare organizations have signed on as early adopters in its Electronic Prior Authorization Acceleration initiative, expanding a federal push to move prior authorization away from fax, phone and paper workflows. The list includes Epic, Oracle, Cleveland Clinic and Kno2, according to a CMS press release and the agency’s early-adopter page. CMS said the initiative is meant to address workflow, technical and operational barriers before federal electronic prior-authorization requirements take effect on January 1, 2027. ### Which companies actually joined the CMS initiative? CMS named Cleveland Clinic, Providence, Rush University System for Health and Sanford Health among provider organizations that joined the effort. The agency also listed Epic, Oracle, athenahealth, eClinicalWorks, MEDITECH, Modernizing Medicine and TruBridge among electronic health record developers, alongside networks including b.well Connected Health, CommonWell, eHealth Exchange and Kno2. (cms.gov) CMS said those 29 organizations are joining health plans that had already signed on, including Aetna, Blue Shield of California, Cambia Health Solutions, Cigna, Elevance, Highmark, Horizon Blue, Humana and UnitedHealthcare. ### What is CMS trying to change before 2027? CMS said the initiative is designed to support electronic prior authorization for medical items and services ahead of the January 1, 2027 deadline in the CMS Interoperability and Prior Authorization final rule. (cms.gov) The agency said the rule requires certain payers to support API-enabled data exchange using FHIR-based standards, defined timeframes for decisions and public reporting of prior-authorization metrics. Dr. Mehmet Oz, the CMS administrator, said in the May 13 release that prior authorization “won’t be fixed by technology alone” and requires the healthcare system to work together on “real-world challenges.” In a May 5 CMS blog post, Oz wrote that prior authorizations cost providers $20 to $50 per hour and take an average of 13 hours a week. (cms.gov) ### Why are Epic and Oracle part of this instead of just insurers? CMS said the new phase adds health systems, hospitals, physician practices, EHR vendors and digital health developers to an effort that had previously centered on payer commitments. The agency said committed working groups across those stakeholders will align on final-rule deadlines and address workflow gaps and technical handoffs “that no single sector can fix alone.” (cms.gov) That structure helps explain why Epic and Oracle appear on the same roster as Cleveland Clinic and national insurers: CMS is trying to build end-to-end workflows that connect ordering clinicians, EHR systems, intermediaries and payers in the same transaction path. That is an inference from the agency’s published participant list and description of the working groups. (cms.gov) ### Where does Kno2 fit in? Kno2 appears on CMS’s Electronic Prior Authorization early-adopter page under networks. The company has also published multiple statements this year tying itself to CMS interoperability work, including an April 9 post saying CMS invited Kno2 and partner companies to demonstrate capabilities across pledge categories at a national showcase in Washington. (cms.gov) Kno2’s website says its network supports prior authorization workflows and promotes a product called Kno2 PreCheck, which the company describes as a privacy-focused way to locate patient data without centralized storage of protected health information. I could not independently verify from primary sources the separate social-media claim that Kno2 announced on May 18 that it was piloting integration capabilities specifically for this initiative. (cms.gov) ### What about DenyZero’s “pre-check” claim? DenyZero’s website says it scores emergency-room claims against payer-specific denial rules and drafts appeals before claims leave a billing system. The company describes the product as AI ER coding for community hospitals and says it flags denial risk against payer-specific rules. I could not verify from DenyZero’s website alone the more specific social-media wording that it validates claims against payer local coverage determinations and prior-authorization rules before submission. (kno2.com) The company’s public materials do show rule-checking and denial-risk scoring as part of its pitch. CMS said the next concrete milestone is January 1, 2027, when the federal electronic prior-authorization requirements take effect for certain impacted payers. (denyzero.com) The agency’s early-adopter page and press release remain the primary public roster for named participants including Epic, Oracle, Cleveland Clinic and Kno2. (cms.gov)