The healthcare industry has long recognized the inefficiencies of prior authorization (PA) processes, which have historically been plagued by delays, administrative burdens, and provider frustration. However, as we look ahead to 2027, mandated interoperability advancements offer a promising solution. The question is: will providers adopt it immediately? And what can payers do now to ensure a seamless transition?
Will Providers Use Interoperability for Prior Authorization?
The short answer: It depends. While interoperability solutions offer the potential to streamline prior authorization, providers will ultimately adopt them only if they perceive a clear value. This means the process must be faster, easier, and less burdensome than current methods. Adoption will hinge on usability, integration within existing EHR/EMR systems, and tangible benefits such as reduced administrative effort and improved patient outcomes.
Barriers to Provider Adoption
Despite the promise of interoperability, providers face several barriers to adoption:
- EHR/EMR Access & Integration: Many providers rely on legacy systems that may not be ready to seamlessly integrate with new prior authorization APIs.
- Technology Gaps: Smaller practices and independent providers may lack the IT resources to implement and maintain these solutions effectively.
- Cost Considerations: Even if the technology is available, providers will weigh implementation costs against potential time savings and reimbursement improvements.
- Training & Workflow Disruptions: Any change requires training and workflow adjustments, and busy healthcare providers may be resistant to temporary inefficiencies.
Payers Must Engage Providers Now
Rather than waiting for interoperability mandates to take full effect in 2027, payers should proactively engage with their provider networks today. By initiating discussions now, payers can:
- Gauge provider interest and readiness for API-based prior authorization.
- Identify key barriers and strategize ways to overcome them—whether through funding support, training, or technology partnerships.
- Build trust and collaboration, ensuring a smoother transition when interoperability solutions become widely available.
Payers and providers share the common goal of improving patient outcomes – and taking every opportunity to collaborate on solutions and future opportunities also enables building strategic relationships to solve other challenges, such as enabling value-based care.
How Early Engagement Benefits Payers
In 2026, payers will be required to publicly report prior authorization data, including approval rates and turnaround times. This increased transparency will put pressure on payers to improve performance and demonstrate efficiency. By starting the conversation with providers now, payers can:
- Reduce friction in the transition to interoperability, ensuring faster adoption in 2027.
- Improve authorization processing times, which will reflect positively in public reporting.
- Differentiate themselves in the market by offering providers a more seamless, value-driven experience.
The Road to 2027
The shift to interoperable prior authorization is not just a regulatory mandate—it’s an opportunity to improve healthcare administration and patient care. However, successful implementation will require a deeper collaboration between payers and providers. By acting now, payers can pave the way for a more efficient, transparent, and provider-friendly future.
HealthAxis remains committed to supporting our partners in this transition. The time to prepare is now—let’s build a smarter, more connected healthcare ecosystem together. Schedule a demo today to learn more.
Author:
Vice President of Product Management
