The missing piece in prior authorization reform? Providers, some argue.

Prior authorization reform efforts so far have largely focused on what payers should be doing differently. That’s changing.

On May 5, the Centers for Medicare and Medicaid Services (CMS) announced a new coalition. As usual, it includes some major payers. But now it also includes health systems such as Cleveland Clinic, technology companies like eHealth Exchange, and electronic health records (EHR) companies like Epic to work on speeding up prior authorizations, which providers argue contribute to burnout and delay necessary care, sometimes with deadly patient consequences.

This coalition has pledged to work toward making electronic prior authorization more commonplace. CMS requires many payers to offer it starting Jan. 1, 2027.

This new initiative follows a pledge in June 2025 from major health insurers like UnitedHealthcare to reform the prior authorization process. Though April data from the Blue Cross Blue Shield Association found that insurers have reduced prior authorizations by 11% since then, care delays persist. And the pledge hasn’t convinced doctors, either: Only 1 in 3 physicians believe it will have any impact, per an American Medical Association (AMA) survey released May 13.

Doing things differently. Jordan Ruch, CIO of New Jersey-based AtlantiCare, one of the health systems that signed CMS’s new pledge, told Healthcare Brew that involving doctors and EHRs will make this effort more effective. It’s important to include providers in this process to ensure reform ideas make sense not just in theory but in clinical practice, he added.

“I think the reason providers haven’t seen a lot of difference is we didn’t have everyone at the table yet,” Ruch said.

CMS Administrator Mehmet Oz was blunter in making a similar point at the Axios Future of Health Summit on May 13, when he announced that 29 healthcare players, including providers, had signed the new electronic prior authorization pledge.

“The payers, the insurance companies, have been playing ball. Guess who’s not been playing ball until today? The providers,” he said, per Axios.

Call me maybe? The “early adopters” of this initiative will work to introduce electronic prior authorization into their workflows, reduce reliance on phones and faxes, and “increase visibility into authorization status and decisions,” per a CMS release.

“We’re working together really to automate what is a broken and manual process,” Ruch said. “There are portions of that workflow that are things that we can control within the provider space.”

Health insurance industry lobbyist America’s Health Insurance Plans (AHIP) surveyed health plans in 2024 and found nearly half of providers’ prior authorization requests were submitted using phone, fax, or even postal mail.

One obstacle is that only about 1 in 4 doctors from the AMA survey said their EHR offers electronic prior authorization for prescription medications, and of respondents who reported submitting prior authorizations for medications, 27% said the information in their e-prescribing system is “rarely or never accurate.”

“We don’t want to use fax machines. We don’t want to make 10 telephone calls. Eligibility and prior authorization is a big opportunity for us to just make real improvements, learning from other industries on how we can communicate better,” Ruch said.