What CMS’ 2027 AI rule means for prior authorization (and maybe for fax machines)

Health plans have until Jan. 1, 2027, to comply with CMS-0057-F, the CMS Interoperability and Prior Authorization Final Rule, which requires health plans to run four standardized electronic systems, including one built specifically for prior authorization requests.

It’s a shift in technology that could move U.S. health care toward quicker prior authorizations and greater use of artificial intelligence (AI), and away from facsimile machines, if all goes according to plans by the U.S. Center for Medicare & Medicaid Services.

In May 2026, Cohere Health joined the new CMS Electronic Prior Authorization Acceleration Initiative, a coalition of health plans, providers and technology vendors working to meet that deadline. Company Chief Medical Officer Brian Covino, M.D., an orthopedic surgeon, spoke with Medical Economics about progress now and scheduled to start next year.

While the countdown is on, an American Medical Association survey this year found physicians remain skeptical that any of this will change much. Only 33% believe a widely publicized 2025 pledge by dozens of insurers to streamline prior authorization will make a meaningful difference, according to those findings.

This transcript has been edited for length and clarity.

What is electronic prior authorization, and how does it differ from what most physicians deal with today?

Electronic prior authorization, to say it in a short fashion, is really using technology to retire the fax machine, which you've heard CMS Director Dr. Mehmet Oz say as well. It's a way for us to electronically submit requests for prior authorization and have the communication be electronic, as opposed to over the telephone, via fax or via email. It's much more efficient, and it can speed up access to good care. It's also an easier way for physicians and their staff to submit and receive information, so there's less back and forth, fewer phone calls, fewer people waiting on hold. We've seen this in our own use of our electronic system: When we survey providers and their staff, 94% say the electronic format is wonderful. It's well received once they get used to using it.

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Why has health care been slower than other industries, like financial services, to adopt electronic communication?

That's a good question. I would have to say that maybe in health care we're a little more conservative and resistant to change than in other industries. But you're exactly right: The same individuals who are submitting prior authorization requests are using electronic formats for their financial business. They all shop on Amazon. I think what we'll see moving forward is that once physicians and staff know electronic prior authorization is available, they'll use it, they find that it’s easy to use. We also have a good provider success team in our organization that does a lot of the training, sits at their elbow and is always willing to answer questions if they have problems. That help-desk approach really helps get them using the system on a regular basis.

You mentioned the fax machine a moment ago. Is that a metaphor for old technology, or are there still practices literally using fax machines?

Absolutely, there are. We know from some of our clients, when we first start working with them, that their prior authorizations are still 100% on the fax machine. Fortunately, once we move them to electronic methods, usually within a month or two we can convert from 100% fax to less than 5% fax, so the adoption is pretty rapid. I would also say that, though it's a small percentage, we still receive documents that are handwritten — believe it or not, medical records that are still handwritten — and we have systems in place where we can actually read the handwritten notes and convert them into a digital format so we can use them in the electronic system.

CMS has set a Jan. 1, 2027, deadline for health plans to comply with new interoperability mandates. What happens between now and then?

CMS-0057-F, which you're referring to, goes into effect at the beginning of 2027. We created our system and our platform to be compliant with that from the very beginning, we knew this was coming a few years ago. So the clients we have who are using our platform are already compliant. We're seeing an uptick in communications from health plans that haven't solved this problem yet, asking if we can solve it for them. Everybody's trying to get to that place. There are advantages to solving this interoperability problem: It's going to make communication more efficient, it's going to save physicians and their staff time, and most importantly, it's going to save members time in terms of their ability to get the care they actually need.

An AMA survey found only 33% of physicians believe insurers' pledges to streamline prior authorization will make a meaningful difference. What do you say to skeptical physicians?

I understand the skepticism. In some cases it may be warranted. As a physician myself, I've heard things before, and oftentimes they don't come to fruition. But what I would say is I would urge physicians to embrace it, to get involved, to understand it. The more they get involved and understand what's being asked and proposed, the more it's going to make their lives easier, because in the end all of this is going to make physicians' lives better, their staff's lives better and their patients' lives better. Patients are going to get appropriate care faster. So all I can say is: Educate yourself, spend the time, get involved in the process. If you have comments or questions, get involved and learn how to participate. Don't just close the book on it and assume it's going to go away.

What's required for an appeal, and how long does that process typically take?

Once a case is “denied,” different lines of business have different rules for how long you have to wait before you can resubmit. In Medicare Advantage, for instance, once you have a denial, you may have to wait 45 to 60 days before you can resubmit. In one of the newer Medicare programs, called the WISeR model, you can actually resubmit as many times as you want after getting a non-affirmation. So it's variable, but the process isn't all that fast. We're now using our platform in the appeals process for some of our health plan clients to expedite it, too, whether that's getting more information after a denial has been rendered, so we can read that quickly and get an answer back without going through a lengthy appeal. Using our platform and using AI appropriately, we're actually going to reduce the number of appeals, because we're reducing the number of denials in the first place. And the denials that are rendered are more likely to be appropriate, genuine patient-safety issues, where we're making sure patients aren't getting care that could harm them. In the long run, I think we'll see a decrease in the time any appeals take.