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Epic, Oracle and Cleveland Clinic Join CMS Prior Authorization Initiative

Posted 17 May 2026 · Updated 17 May 2026 · 3 min read

The Centers for Medicare and Medicaid Services has announced that Epic, Oracle Health, and Cleveland Clinic are among 29 organizations joining its Electronic Prior Authorization Acceleration initiative, signaling a major shift in how clinical teams will request and receive treatment approvals by 2027.

The CMS initiative moves prior authorization from paper forms and fax machines into real-time, interoperable digital pipelines before a mandatory January 2027 deadline. Early adopters commit to embedding electronic workflows directly into EHR systems, using standardized APIs to replace phone calls and faxes, and sharing implementation data with CMS to refine industry standards.

What You Need to Know

Key Takeaways

29 organizations across EHR vendors, providers, and health data networks have joined the CMS Electronic Prior Authorization Acceleration initiative as early adopters.Industry Scale

Epic and Oracle Health are committing to embed electronic prior authorization workflows directly into clinical EHR systems used by health systems nationwide.EHR Vendors

Cleveland Clinic is one of nine major health systems on the early adopter list, reflecting provider pressure to cut delays in oncology, cardiology, and imaging.Health Systems

CMS has already required Medicare Advantage, Medicaid, and Marketplace plans to implement prior authorization APIs by January 1, 2027.Deadline

If successful, the initiative could reduce prior authorization turnaround from days to hours for routine requests, cutting phone calls and faxes significantly.Impact

A total of 29 organizations across EHR vendors, providers, and health data networks have signed on as early adopters, including 9 major health systems. All participants must have electronic prior authorization workflows embedded in clinical systems ahead of the January 1, 2027 deadline for Medicare Advantage, Medicaid, and Marketplace plans.

Why Epic, Oracle and Cleveland Clinic's Participation Matters

By joining the pledge, Epic and Oracle Health signal that their core EHR platforms will support interoperable, end-to-end electronic prior authorization workflows for provider systems nationwide. Cleveland Clinic's inclusion reflects pressure from large health systems to cut delays in high-volume specialties where authorization backlogs have the most direct impact on patient care.

Early Adopters — Key Organizations

EHR Vendor

Epic

Epic's EHR — used by large health systems and community practices — can surface prior authorization requests directly inside clinician notes, eliminating workflow interruptions.

EHR Vendor

Oracle Health

Oracle's cloud and integration tools can connect prior authorization requests to payer decision engines in real time, reducing manual follow-up across clinical and administrative teams.

Health System

Cleveland Clinic

One of nine major health systems joining the initiative, representing provider pressure to reduce authorization delays in oncology, cardiology, and advanced imaging.

Source: CMS Press Release · Healthcare Dive

What This Means for Clinical Teams

If the initiative succeeds, clinical teams could see:

Faster approvals

API-driven exchanges may reduce routine request turnaround from days to hours, according to the CMS blog on moving prior authorization into the 21st century.

Fewer phone calls and faxes

Automated status tracking and embedded payer responses inside the EHR could significantly cut the time clinical staff spend chasing faxes and voicemails.

Better patient experience

Quicker decisions reduce treatment delays and coverage uncertainty, particularly for time-sensitive or urgent care where authorization backlogs most directly affect outcomes.

Source: CMS Blog — Moving Prior Authorization into the 21st Century

CMS Prior Authorization — Key Milestones

✓

January 2024

CMS Interoperability and Prior Authorization Final Rule

CMS finalized the rule requiring certain payers to implement prior authorization APIs.

Completed

→

2025–2026

Early adopter pilot testing

29 organizations begin pilot testing with selected payers. CMS uses performance data to refine standards.

In Progress

January 1, 2027

Prior authorization API deadline

Medicare Advantage, Medicaid, and Marketplace plans must implement prior authorization APIs.

Upcoming

Source: CMS Health Tech Ecosystem · CMS Interoperability and Prior Authorization Final Rule

What Still Needs to Happen

⚠

Implementation Challenges

Stakeholders warn that implementation will require careful mapping of clinical rules, payer-specific policies, and specialty workflows, particularly in oncology and advanced imaging. Smaller practices may also need IT support to integrate new tools without additional burden. Early-adopter sites will begin pilot testing over the next year, with CMS refining standards before broader rollout, according to LeadingAge.

The Bottom Line

Prior authorization has long been one of the most time-consuming and frustrating parts of clinical practice. The CMS initiative, backed by Epic, Oracle Health, and Cleveland Clinic, is the most concrete step toward fixing it. Whether it delivers on its promise depends on execution — but the participation of major EHR vendors and health systems makes this the most credible prior authorization reform effort to date.

Got questions?

FAQs

01What is the CMS electronic prior authorization initiative?

The CMS Electronic Prior Authorization Acceleration initiative is part of the agency's Health Tech Ecosystem push to move prior authorization from paper forms and faxes into real-time digital pipelines. 29 organizations have joined as early adopters, committing to embed electronic prior authorization into EHR systems before the January 2027 deadline.

02Which organizations joined the CMS prior authorization initiative?

Epic, Oracle Health, and Cleveland Clinic are among 29 organizations that joined as early adopters, including nine major health systems and several EHR vendors and health data networks. The full list of early adopters is available on the CMS Health Tech Ecosystem page.

03What is the prior authorization API deadline?

CMS has required certain Medicare Advantage, Medicaid, and Marketplace plans to implement prior authorization APIs by January 1, 2027. The CMS Electronic Prior Authorization Acceleration initiative is designed to broaden adoption across providers and vendors ahead of that deadline.

04How will this affect clinical teams?

If the initiative succeeds, clinical teams could see faster approvals with turnaround reduced from days to hours for routine requests, fewer phone calls and faxes, and a better patient experience with reduced treatment delays. The timeline for these changes depends on pilot testing over the next year.

05What challenges remain for prior authorization reform?

Implementation will require careful mapping of clinical rules, payer-specific policies, and specialty workflows, particularly in oncology and imaging. Smaller practices may also need additional IT support to integrate new tools without adding administrative burden.

Written by

Hanna Mae Rico

Hanna Mae Rico is a healthcare communications writer covering clinical operations, patient safety, and the systems shaping frontline care delivery. Her work focuses on translating complex healthcare communication challenges into practical insights for nurses, hospital leaders, and clinical teams navigating high-pressure care environments.

View all articles by Hanna ->

Epic, Oracle and Cleveland Clinic Join CMS Prior Authorization Initiative

Why Epic, Oracle and Cleveland Clinic's Participation Matters

What This Means for Clinical Teams

What Still Needs to Happen

The Bottom Line

Hanna Mae Rico

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