Overview
- Epic said its new Coverage Requirements Discovery (CRD) API delivers insurer coverage rules and prior-authorization requirements inside the electronic health record at the moment a clinician orders care or staff schedule appointments.
- Ochsner Health, Froedtert ThedaCare, Denver Health and Summit Health are live with the CRD connection and are exchanging checks with major insurers that include UnitedHealthcare, Aetna and Network Health.
- The CRD uses the HL7 Fast Healthcare Interoperability Resources (FHIR) standard required by a federal interoperability rule, and CMS is running a 29-participant early-adopter demonstration that includes Epic, Oracle Health and athenahealth.
- Despite the pilots and about 16 additional payers in testing, many providers say they have not yet seen broad, real-world reductions in paperwork, fewer services subject to prior authorization, or clearer insurer communications on decisions.
- If technical connections are paired with clear payer-provider roles and consistent points of contact, the API could cut phone calls and faxes, speed scheduling and reduce delays in care; regulators and providers will watch whether broader insurer rollout translates to those operational gains.