New Digital Interfaces To Simplify Prior Authorization Requests

Sept. 24, 2026

Starting Jan. 1, 2027, we’ll offer application programming interfaces to simplify prior authorization requests and give you quicker access to your patients’ information. These updates, required by the Centers for Medicare & Medicaid Services, are designed to reduce administrative burden and support better treatment decisions. 

This new functionality will apply to Medicare Advantage, Medicaid and select commercial members. We’ll share additional details on impacted commercial members in future communications.

These secure digital interfaces will allow:

• Simplified prior authorization: You’ll be able to easily determine whether prior authorization is required and identify the necessary documentation before submitting a request. You can also update requests and track their status in real time. 

• Accessing patient data through your electronic health record system: To support your patients’ treatment, you’ll have access to the same data as your patient. This includes prior authorization status, encounter data and specific claims data. We’ll apply a process to determine which of our members have a treatment relationship with you and also have not opted out of this data exchange with you. 

Next steps: We’ll share additional details about training, support resources and more in coming months. Watch News and Updates for information.

Refer to frequently asked questions for more information on how APIs integrate with your existing systems and workflows.

If you have questions, please contact your Provider Relations Representative.