WEDI Survey Finds Payers and Providers Making Progress Complying with Interoperability and Prior Authorization Final Rule
Industry Continues to Face Challenges in Meeting 1.1.27 Deadline
WASHINGTON, DC, March 10th, 2026 — The Workgroup for Electronic Data Interchange (WEDI) released results of its recent survey assessing industry readiness to meet the requirements of the Centers for Medicare & Medicaid Services (CMS) Advancing Interoperability and Improving Prior Authorization Final Rule, also known as CMS-0057-F. With just under a year until the compliance deadline, the new survey results demonstrate that while the industry has made some progress, there is more work remaining in implementing, testing, and training to meet the regulatory requirements. This survey, conducted in February, is a follow up to the first two conducted by WEDI in October 2025 and January/February 2025.
CMS-0057-F mandates the use of Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization Application Programming Interfaces (APIs) with the goal of increasing data sharing to streamline prior authorization and patient data exchange. Once implemented, these new data exchange methodologies are expected to deliver much-needed reduction in overall payer, provider, and patient burden. Impacted entities are required to implement the API requirements by January 1, 2027. The rule also requires covered payers to publicly report designated prior authorization metrics by January 1, 2026.
Key results from the survey include:
Payer Responses:
- For the API requirements, 10% have not yet started their work, compared to the previous result of 33% (Oct ’25) and 42% (Jan/Feb ’25).
- In estimating the current stage of completion with implementing the Patient Access API, 35% estimated they are 25% or less completed, down from 66% (Oct ’25). Sixteen percent expect to be 75% to 100% completed by the January 1, 2027, deadline, up from 12% (Oct ’25).
- The majority (28%) estimate a cost of $1 million - $5 million for implementing the API components of the rule, which was the majority (42%, Oct ‘25) response previously. There was a notable increase in an estimated cost exceeding $5 million from 15% (Oct ’25) to 25% (Feb ’26).
- The top three implementation challenges they report facing are: 1) Delegated third parties facing challenges connecting with different systems; 2) Digitizing prior authorization policies; 3) Sufficient funding. The previous responses were: 1) Digitizing prior authorization policies; 2) Meeting compliance timelines; and 3) Delegated third parties facing challenges connecting with different systems (Oct ’25).
Provider Responses:
- Thirty-three percent have not started implementation and testing and 67% was unsure as to the implementation and testing progress. No respondents registered any implementation progress with this round of the survey. Previously forty-seven percent had not started implementation and testing (Oct ’25), down from the previous result of 52%, although 47% expect they will somewhat or very likely meet the January 1, 2027, deadline, down from 69%.
- The majority (67%) remain unsure of the total cost for implementing the requirements and training their employees, up from 55% (Oct ’25).
- Thirty-three percent expect the clinician to directly interact with the API prior authorization process at the point of care with the patient. Others expected to interact with other administrative staff at 33% and 33% were unsure.
- The top three implementation challenges reported are: 1) Sufficient internal expertise; 2) Coordinating with vendors/health plans to test with; 3) Sorting out the various networks and how they interplay (e.g., TEFCA, QHIN, HIE, etc.). The previous responses were: 1) Developing new workflows; 2) Sufficient internal expertise; and 3) Coordinating with vendors/health plans to test with (Oct ’25).
Clearinghouse Responses:
- For payer customers, 60% plan to conduct the API data exchanges for them with 20% unsure, compared to the previous results of 43% and 57%, respectively (Oct ’25). For provider customers, 70% plan to conduct the API data exchanges and 20% are unsure, compared to 57% and 43%, respectively.
Vendor Responses:
- Eighty-two percent plan to assist payers and providers in complying with the API provisions, up from the previous result of 77%.
“Seeing that 43% of payers and 47% of providers have not started their implementation is concerning. While these numbers are improved from our previous survey in January/February, they are still high. We know that installing technology, changing workflows, integrating data streams, and modifying business policies take time, all which need to be completed by January 1, 2027,” stated Robert Tennant, WEDI Executive Director. “The challenges that payers and providers have identified in our survey emphasize their importance in the ability to meet the deadline.” Tennant added, “We see in the survey that vendors and clearinghouses will be assisting payers and providers in meeting the requirements, but it is unclear if that assistance will bring these impacted entities into compliance by the deadline.”
Additional survey results:
- Most respondents (53%, down from 68%) were supportive of staggering implementation of the three prior authorization requirements: Coverage Requirements Discovery (CRD), Document Templates and Rules (DTR), and Prior Authorization Support (PAS), currently all required to be implemented on January 1, 2027. Thirty-three percent favored starting with the CRD, followed by the DTR and then PAS as the staggered implementation approach.
- Most providers (66%) view having the majority of their payers supporting the prior authorization API requirements as extremely important, up from 56%.
- Thirty-three percent of providers indicated they are somewhat or very likely to implement the Provider Access API, down from 44%.
- All stakeholders identified that 1) Education on industry best practices; 2) Education on workflow design/modification; and 3) Advanced education (technical) on implementing APIs were the top educational resources needed for implementation of the CMS-0057-F requirements, which was the same result from the previous survey.
“WEDI plans to repeat this survey again in the first quarter of 2026. It will be important to track the industry’s progress in meeting these requirements,” said Tennant.
The survey questionnaire, developed by WEDI leadership and the WEDI Prior Authorization Subworkgroup, was open to the industry in February 2026. A total of 86 responses were completed and represented 52% payers, 5% providers, 12% clearinghouses, and 31% vendors. Access the complete survey results here.
About WEDI
WEDI was formed in 1991 by then HHS Secretary Dr. Louis Sullivan to identify opportunities to improve the efficiency of health data exchange. WEDI was named in the HIPAA legislation as an advisor to the Secretary of HHS. Recognized and trusted in this role, WEDI is the leading authority on the use of health information technology to efficiently improve health information exchange, enhance care quality, and reduce costs. With a focus on advancing standards for electronic administrative transactions, and promoting data privacy and security, WEDI has been instrumental in aligning the industry to harmonize administrative and clinical data.
For more information, please visit wedi.org.
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Contact:
Lindsey Canaley, WEDI
202.320.7618
lcanaley@wedi.org