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Preparing for 2027 Prior Auth Regulatory Requirements

· 2 min read
Reshma Khilnani
Reshma Khilnani
Medplum Core Team

Prior authorization is one of the biggest sources of administrative burden in healthcare, and it is now the subject of a regulatory deadline. CMS-0057-F and HTI-4 require payers and providers to support electronic prior authorization workflows built on FHIR, with enforcement beginning January 2027.

Medplum supports ePA transactions for payers AND providers and has earned the 2026 FHIRplace Participant emblem from Drummond Group for our engagement in electronic prior authorization (ePA) testing.

FHIRplace Participant 2026 emblem

FHIRplace is Drummond's multi-party interoperability testing program, where payers, providers, and health IT vendors test real FHIR exchanges against each other rather than against a reference implementation. The Participant emblem recognizes active engagement in FHIRplace testing for 2026. Multi-party validation is ongoing, and we will share results as we complete them.

Why ePA testing matters​

Medplum is pursuing certification for all three mandatory ePA criteria: Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS).

The way to prove these workflows is to test them with real payers and providers. Our electronic prior authorization guide describes how implementation partners can connect to our staging environment and begin CDS Hooks testing with us today.

This work is part of the compliance and revenue cycle themes on our 2026 roadmap. If you are a payer, intermediary, or provider organization preparing for the 2027 enforcement date, reach out to hello@medplum.com.

The FHIRplace Participant mark is a trademark of Drummond Group, LLC. HL7® and FHIR® are registered trademarks of Health Level Seven International.