Epic, Froedtert ThedaCare and Sanford Health participate in CMS electronic prior authorization initiative
Three healthcare organizations with Wisconsin ties are among the early adopters of a federal initiative to modernize prior authorization.
In mid-May, the Centers for Medicare and Medicaid Services said 29 healthcare organizations signed up for its electronic prior authorization initiative, including Froedtert ThedaCare; Sanford Health, which Marshfield Clinic joined; and Verona-based Epic, the electronic health records vendor.
Together, they’ll work to integrate electronic prior authorization into clinical and administrative systems, reduce reliance on manual processes, boost visibility of requests’ statuses and denials, and address gaps and hand-offs between different systems.
“These early adopters are choosing to lead,” CMS Administrator Dr. Mehmet Oz said in a statement. “This work will help reduce administrative burden, giving clinicians more time to focus on patients and helping people get care faster.”
The project is part of a broader effort pursued by CMS to modernize healthcare. In June 2025, major insurers and payers pledged to simplify prior authorization, reduce administrative tasks and standardize policies.
While electronic transactions for prior authorization have been around for a while, adoption has been poor, said Jim McDermott, vice president of research and development for health plan products at Epic. In 2024, CMS required that all health plans adopt a new standard for prior authorization exchange by Jan. 1, 2027.
However, players in the industry have taken different interpretations of that standard, leading to fears that aligning could be a “painful process” after that deadline, McDermott said. The early adopters will work on making connections now.
“Let’s roll up our sleeves, get this connected, work through the kinks, so that with this smaller group, we’ve figured out how to do it,” McDermott said. “So that, come 2027, as the broader industry does it, it’s an established pattern and they have success to look towards.”
Streamlining and reducing the administrative burden of prior authorization will require payers, providers and other EHR vendors to “lock arms and work together,” McDermott said.
Froedtert ThedaCare CEO Dr. Imran Andrabi said they’ll work with other initiative participants “to move beyond technical readiness and address how electronic prior authorization functions in real-world settings.”
“Put simply, the goal is to make electronic prior authorization work end-to-end, on time and consistently for every patient,” Andrabi said in a statement.
Sanford Health said they look forward to working “across the healthcare ecosystem to help advance patient-centered prior authorization solutions.”
“We know how important it is for patients to receive the right care at the right time and remain committed to simplifying the care experience,” Sanford said in a statement.
Last July, Froedtert ThedaCare, Epic and Sanford joined a CMS effort to improve data exchange and pursue other digital health projects.
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