The U.S. Department of Health and Human Services (HHS), in collaboration with over 45 of the nation’s largest health insurers, has announced an important step forward in transforming the problematic processes of prior authorization. By pledging to reduce delays, increase transparency, and standardize processes by 2027, these organizations have signaled a long-overdue shift toward easing administrative burdens and improving access to evidence-based care.
The pledge spans insurance markets (commercial coverage, Medicare Advantage and Medicaid managed care) and will benefit an impressive 257 million Americans. But turning that vision into reality will require more than declarations. It will demand the kind of trusted technical infrastructure that HL7’s community has built together for over 35 years.
As implementation begins, prior authorization reform demands scalable, open and consensus-driven standards.
HL7 FHIR® as the Foundation
A critical element of the announcement by HHS is the commitment to use HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard for real-time data exchange between providers and payers. FHIR is already required under several CMS interoperability rules, and its adoption is growing across both public programs and commercial health plans.
As a foundational platform standard, FHIR supports a wide variety of healthcare workflows. Yet declaring 'we'll use FHIR' isn't enough for processes as complex as prior authorization—what matters is how it's implemented: with fidelity, consistency and interoperability.
HL7’s Da Vinci Project has emerged as both the leading community of practice and technical visionary on this challenge. Da Vinci has developed and maintains FHIR implementation guides, testing tools and real-world pilots specifically for prior authorization. These assets are available to the entire industry—and they’re essential for moving from policy promise to operational reality.
Standards as Infrastructure
Data standards like FHIR exemplify digital public infrastructure—foundational systems that must be open, interoperable and governed for the public good. Like the roads, water systems, and broadband networks that enable physical connectivity, FHIR is a core component of the digital backbone that enables secure and seamless healthcare interactions between patients, providers and payers.
With strong public-private alignment, implementation at scale is possible. But to achieve this, we must address more than technology, we must prioritize workforce training, equitable access for small and rural providers, and a shared governance model that reinforces trust and transparency.
A Shared Responsibility
HL7 has long served as the convener for innovative cross-sector collaboration. Through open processes and deep stakeholder engagement, together we build the technical scaffolding that allows new interoperability initiatives to take root and flourish.
Now, with national attention focused on prior authorization reform, the healthcare ecosystem has an opportunity, and a responsibility, to deliver real improvements for patients, providers and plans alike.
The path forward is clear. The data standards and technologies are here. What’s needed now is implementation at scale and the collective will to follow through.
We’re ready. Let’s get to work; together.