Written by Jessica Miller · Published November 13, 2026 · Last reviewed November 13, 2026
Reviewed by: Jessica Miller, MHA, CPC, CPC-I, Head of Coding Operations
ONC and CMS opened voluntary electronic prior authorization testing on November 12, 2026. Payers, providers, hospitals, EHR developers and intermediaries can join 10 to 12 week sprints in production-like environments. Interest is due November 20, 2026. Joining is not ONC certification and is not a CMS compliance determination.
| Item | Date | Who it applies to | Binding? |
|---|---|---|---|
| ONC and CMS testing initiative announced | November 12, 2026 | Payers, providers, hospitals, EHR developers, and intermediaries (voluntary) | No. Participation is voluntary |
| Expressions of interest due | November 20, 2026 | Same groups | No. No time of day is printed |
| Sprint length | 10 to 12 weeks per sprint | Participants | No. Drummond calls 10 to 12 weeks the minimum cycle |
| Initiative window | Through September 2027, per Drummond | Participants | No. ONC does not publish an end date |
| Specific denial reason, and 7-day or 72-hour decisions | January 1, 2026, for Medicare Advantage and state Medicaid and CHIP fee-for-service; the rating period or plan year beginning on or after January 1, 2026, for other impacted payers. Qualified Health Plan issuers on the Federally Facilitated Exchanges are excluded from the timeframes | Impacted payers under CMS-0057-F | Yes |
| Public prior authorization metrics | Beginning March 31, 2026 | Impacted payers | Yes |
| Prior Authorization API | January 1, 2027, for Medicare Advantage and state Medicaid and CHIP fee-for-service; the rating period or plan year beginning on or after January 1, 2027, for managed care and Qualified Health Plan issuers on the Federally Facilitated Exchanges | Impacted payers. Medicare fee-for-service is not directly covered. Drugs are excluded | Yes |
| MIPS Electronic Prior Authorization measure | Calendar year 2027: optional, 10 bonus points. Calendar year 2028: required | MIPS eligible clinicians. CMS says it finalized the same policy for the Medicare Promoting Interoperability Program | Optional in 2027, required in 2028 |
| Da Vinci CRD, DTR, and PAS required for payer APIs, and drugs added to the API | Proposed for October 1, 2027 | Impacted payers, if finalized | Proposed only, in CMS-0062-P |
Table sources: the ONC news release , CMS-0057-F, 89 FR 8758 , the CY 2027 Physician Fee Schedule final rule , and Drummond's November 11, 2026 release .
What did ONC and CMS announce on November 12, 2026?
ONC, working with CMS, announced industry testing events for end-to-end electronic prior authorization. Payers, providers, hospitals, EHR developers and intermediaries will test their own workflows across connected systems in production-like environments, so gaps can be found before a broader rollout.
This is a testing sprint, not a new rule. Tom Keane, M.D., the National Coordinator for Health IT, said: "Federal regulations and industry standards have laid important groundwork for ePA, but our work is not done." ONC and CMS "intend to use the findings to quickly identify and prioritize critical improvements to standards, educational materials and implementer guidance." The announcement talks about testing "ahead of 2027 requirements." It does not name CMS-0057-F, the CMS Interoperability and Prior Authorization final rule that sets the 2026 clocks and the 2027 Prior Authorization API dates below.
How do the electronic prior authorization testing sprints work?
Testing runs in 10 to 12 week sprints. Participants use their own workflows to see how prior authorization requests and decisions move between systems. Drummond Group operates FHIRplace, a virtual environment where matched trading partners test together, and the MITRE-led Health FFRDC supports recruitment, readiness discussions, participant matching and coordination.
ONC says first-round space is limited, and that later testing opportunities will be announced. Drummond's interest page says you do not need a production-ready build: "Participants with working or in-development implementations can register." It also describes a continuous testing model with a "minimum 10-12 week testing cycle," issue identification, and retesting.
Drummond's November 11 press release says the initiative "is available now and runs through to September 2027." That end date is Drummond's wording. It does not appear on the ONC news or blog pages.
What are Da Vinci CRD, DTR, and PAS?
They are three HL7 FHIR implementation guides from the Da Vinci project, used here as industry background for FHIR prior authorization workflows. Coverage Requirements Discovery tells the provider whether a service needs prior authorization. Documentation Templates and Rules surfaces what documentation the payer wants. Prior Authorization Support carries the request and returns the decision.
The testing sprints use those three guides. CMS-0057-F does not require them. The rule requires HL7 FHIR, US Core, and SMART App Launch for the Prior Authorization API, and it only recommends the Da Vinci guides, "recommending, but not requiring, specific versions of the IGs." A proposed rule, CMS-0062-P, would require payer APIs to conform to CRD, DTR, and PAS, with compliance generally beginning October 1, 2027, if finalized. It is still a proposal.
ONC's HTI-4 rule added provider-side certification criteria for the same three guides, at 45 CFR 170.315(g)(31), (g)(32), and (g)(33). That is a certification topic, not a reason to treat the sprints as a certification event. For later ONC certification changes, see our post on the HTI-5 final rule .
Who can participate, and is the November 20 deadline firm?
ONC invites payers, providers, hospitals, EHR developers, intermediaries and other partners, including smaller and rural organizations. Interest is due November 20 through a Drummond form linked from the ONC release. First-round space is limited, and ONC says more testing opportunities will be announced later.
The ONC pages print "November 20" with no year, time of day, or time zone. Given the November 12, 2026 announcement date, write that as November 20, 2026, and do not invent a cutoff time. The "express interest" link goes to a Drummond FHIRplace form , not a form on healthit.gov.
Does joining count as certification or CMS compliance?
No. ONC states that participation is voluntary and that testing activities do not constitute certification under the ONC Health IT Certification Program or a determination of compliance with CMS requirements. Passing a sprint does not mean a payer has met CMS-0057-F or that an EHR is certified.
The sprints can surface workflow gaps. They are not a stamp, and they do not replace the payer API work or the documentation and coding work that still sits with your team.
What are the CMS-0057-F prior authorization dates for payers?
CMS-0057-F set operational rules from January 1, 2026: a specific denial reason, decisions within 7 calendar days for standard and 72 hours for expedited requests, and public metrics from March 31, 2026. Those 2026 rules apply across channels, not only through an API. Impacted payers must have a Prior Authorization API by January 1, 2027, or the rating period or plan year starting on or after that date. CMS's rule page, last modified October 8, 2026, states the same split: certain provisions by January 1, 2026, and "until primarily January 1, 2027" for the API requirements.
Impacted payers are Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan issuers on the Federally Facilitated Exchanges. Medicare Advantage and state Medicaid and CHIP fee-for-service programs must meet January 1, 2027. Managed care uses the rating period beginning on or after that date. Qualified Health Plan issuers on the Federally Facilitated Exchanges use plan years beginning on or after that date, and they are excluded from the 72-hour and 7-day decision clocks.
Medicare fee-for-service is not an impacted payer. CMS wrote that "these requirements do not directly pertain to Medicare FFS." Original Medicare prior authorization, including the WISeR model, stays in its own lane; see our post on WISeR prior authorization for skin substitutes . Drugs are excluded from the CMS-0057-F Prior Authorization API and process rules. CMS-0062-P would add drugs later if finalized.
The API must list covered items and services, identify documentation requirements, and return an approval with an end date or circumstance, a denial with a specific reason, or a request for more information. That is a payer build, not a rule that every provider must submit every request through the API in 2027.
Do physician groups and hospitals have to use electronic prior authorization in 2027?
Not as a hard requirement in 2027. CMS's CY 2027 Physician Fee Schedule final rule made the MIPS Electronic Prior Authorization measure optional, worth 10 bonus points, for the CY 2027 performance period, and finalized it as required starting with CY 2028. CMS says it finalized the same policy for the Medicare Promoting Interoperability Program, and points to the FY 2027 IPPS final rule for that hospital-side approach; this post cites that point as CMS stated it in the Physician Fee Schedule rule.
The measure asks whether, for at least one medical item or service excluding drugs, the clinician requested prior authorization electronically from a Prior Authorization API using data from certified health IT. A "yes" in 2027 can earn 10 bonus points. For other CY 2027 payment-rule coding changes, see our CY 2027 Physician Fee Schedule final rule post.
What should revenue cycle and coding teams do now?
Treat 2027 as a documentation year. Electronic prior authorization moves the payer's documentation rules earlier, into the order. An electronic approval still has to match what you later code and bill. If a payer authorizes a stated CPT or HCPCS code, units, a modifier, and a diagnosis, and the claim goes out with a different code, extra units, a new modifier, or another diagnosis, the authorization does not, by itself, mean the claim will be paid.
Here is a short, illustrative case, not a real patient. A surgeon's office obtains electronic approval for a single outpatient procedure, two units, and a specific diagnosis. On the day of service, the note supports a related but different procedure code, or a third unit, or a modifier that was never on the request. The authorization file looks clean. The claim does not. That gap is a coding and documentation handoff, not an API failure. The same trap shows up in WISeR prior authorization for skin substitutes and Botox prior authorization in hospital outpatient departments . Commercial lists still change on their own calendar, as in the UHC pediatric prior authorization changes . Track denial reasons by category, including coding-related denial (CARC) codes .
Ask your EHR vendor and your major payers which CRD, DTR, and PAS capabilities will be live, and for which plans and services. Keep portal, phone, and fax fallbacks. Make sure the service, units, modifiers, and diagnosis on the authorization are the ones your coders will see when the chart is coded. That is AI medical coding work in the ordinary sense: complete, specific documentation and consistent codes, before the claim goes out.
How MediCodio AI addresses it
MediCodio AI is coding and documentation support. It does not submit, track, or decide prior authorization requests, and it is not a FHIR, HL7, Da Vinci, or electronic prior authorization product.
Electronic prior authorization moves the payer's documentation questions earlier. The codes still have to match what the chart supports. Complete charts flow through AutoPilot for fully autonomous coding. Charts where the documentation is thin or contradictory stay in CoPilot, where certified coders review and finalize the output. Every code ships with its documentation passage and the compliance rule behind it, a 100% code-level audit trail your team can use to see why each code was assigned.
What has not changed
Payers still have to decide requests and give a specific reason when they deny them, on the 2026 clocks, whether the request arrives through an API, a portal, or a fax. Providers still have to document the service that was performed and bill the codes that documentation supports. Existing Medicare prior authorization programs, and each commercial payer's own list, still apply in their own settings.
Frequently asked questions
What is the ONC and CMS electronic prior authorization testing initiative?
It is a voluntary program, announced November 12, 2026, in which payers, providers, hospitals, EHR developers, and intermediaries test end-to-end prior authorization workflows in 10 to 12 week sprints, in production-like environments, using the HL7 FHIR Da Vinci CRD, DTR, and PAS guides. The sprints are meant to find gaps, not to certify a system.
How do organizations join, and when is the deadline?
Express interest by November 20, 2026, through the Drummond FHIRplace form linked from ONC's announcement. The ONC pages print no time of day or time zone, so do not assume a cutoff hour. First-round space is limited. ONC encourages organizations of all sizes, including smaller and rural ones, and says it will announce more opportunities later.
Does participating mean a payer is compliant with CMS-0057-F or an EHR is certified?
No. ONC states that participation is voluntary and that testing activities "do not constitute certification under the ONC Health IT Certification Program or a determination of compliance with CMS requirements." Passing a sprint does not mean a payer has met the 2027 Prior Authorization API rules, or that an electronic health record is certified.
When must payers offer a Prior Authorization API?
Under CMS-0057-F, Medicare Advantage and state Medicaid and CHIP fee-for-service programs must have one by January 1, 2027. Medicaid and CHIP managed care use the rating period, and Qualified Health Plan issuers on the Federally Facilitated Exchanges use the plan year, beginning on or after that date. Medicare fee-for-service is not directly covered, and drugs are excluded.
Do clinicians have to request prior authorization electronically in 2027?
No. The CY 2027 Physician Fee Schedule final rule made the MIPS Electronic Prior Authorization measure optional, with 10 bonus points, for the CY 2027 performance period. CMS finalized it as required starting with the CY 2028 performance period. CMS says it finalized the same optional-then-required approach for the Medicare Promoting Interoperability Program.
Book a Demo and we will run an accuracy check on a sample of your own charts, with the documentation passage and rule behind every code, before you commit to anything. Book a Demo
Sources
- ONC, ONC and CMS Launch Industry Electronic Prior Authorization Testing Initiative , November 12, 2026.
- ONC, ONC and CMS Launch Industry Initiative Advancing Electronic Prior Authorization Testing , November 12, 2026.
- Drummond Group, interest form for the testing initiative .
- Drummond Group, Drummond Supports Mitre in Advancing Nationwide Payer API Testing , November 11, 2026.
- Federal Register, CMS Interoperability and Prior Authorization final rule (CMS-0057-F), 89 FR 8758, doc 2024-00895 , February 8, 2024. Full text .
- CMS, CMS Interoperability and Prior Authorization Final Rule fact sheet , and the CMS-0057-F rule page (last modified October 8, 2026).
- Federal Register, CY 2027 Physician Fee Schedule final rule, 91 FR 70992, doc 2026-22743 , November 9, 2026. Full text .