Follow the rules. Understand the workflow. Protect access to care.
Source-backed reporting and analysis connected to the companies, capabilities, authorities, and operating domains it affects.
CMS's current Prior Authorization API FAQ says a Coverage Requirements Discovery response can identify whether prior authorization is required and what documentation is needed, but does not itself submit the request or start the payer's decision timeframe. Operators need separate discovery, submission-receipt, information-request, determination, notice, and appeal events.
CMS says certain regulated payers must implement and maintain prior-authorization APIs beginning January 1, 2027, and its provider guidance emphasizes roadmaps, modules, testing, training, and pilots. An available interface is an important milestone, but it does not prove that a real request can travel from order to determination without losing evidence, status, or accountability.
Coverage Requirements Discovery can bring payer requirements into a provider workflow before a request is sent. It does not submit or decide the authorization.
