Epic Systems Revolutionizes Prior Authorization with Real-Time Checks

Healthcare provider Epic Systems is making a major move to modernize prior authorization, a process that has been criticized for its high denial rates. The company recently announced collaborations with major insurers like United Healthcare and Aetna to implement real-time checks using a new industry-standard API.

This change will allow clinicians to verify requirements directly within Epic, streamlining workflows and eliminating the need for manual tasks such as phone calls or faxes. The initiative aligns with priorities from the Centers for Medicare & Medicaid Services (CMS) to accelerate electronic prior authorization.

Several health systems, including Ochsner Health, are already adopting this feature, which is part of Epic's expanding role in the complex healthcare landscape. The company says it has been successfully helping doctors and hospitals across the US implement real-time checks with health insurers using a new API called Coverage Requirements Discovery (CRD).

Read More: Podcasts and Audiobooks: A Match Made in Audio Heaven

According to Epic, clinicians and staff can now easily check prior authorization requirements in Epic when placing an order or before scheduling an appointment, eliminating the need for separate insurance portals. The company also confirmed that 16 additional health insurers are testing its system.

The move comes at a time when healthcare business practices are under scrutiny from patients, physicians, lawmakers, and regulators to reduce or eliminate prior authorization. However, it has been a priority of the CMS and the Trump administration to speed up implementation of electronic prior authorization across the industry.

Epic's announcement follows recent calls for reform, with an analysis highlighting the need for change. The company's technology is already used