CMS prior auth FHIR APIs are not a proposed rule. They are a January 1, 2027 hard deadline for MA plans, Medicaid managed care, CHIP, and federally facilitated exchange issuers.
The decision clocks already went live in 2026: 72 hours for expedited requests, 7 calendar days for standard. Specific denial reasons required. Public reporting of PA metrics started this year.
Four APIs due January 2027: Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization. The PA API must accept submissions and return structured approvals, denials with reasons, or info requests.
The APIs solve transport. They do not find the clinical evidence in the chart, judge its sufficiency, or fix the request when a payer bounces it. That workflow gap is where the product value actually lives.
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