Ochsner Health: Prior Authorization Automation Needs Collaboration First

Healthcare organizations have spent years trying to automate prior authorizations, but Ochsner Health is discovering that technology alone won't solve the problem. The key ingredient is getting payers and providers to actually work together.

The nonprofit academic health system joined 28 other organizations in May as an early adopter of the Electronic Prior Authorization Acceleration initiative, part of the Centers for Medicare and Medicaid Services' Health Tech Ecosystem. The program aims to implement electronic prior authorization workflows ahead of a January 1, 2027 regulatory deadline.

Why it matters

Prior authorization delays affect patient care and drive administrative costs for both payers and providers. While the healthcare industry has had the technical standards to automate the process for over a decade, progress has stalled due to lack of coordination and accountability. The CMS initiative demonstrates that structured collaboration frameworks can unlock automation benefits that technology standards alone cannot deliver.

Breaking down decades of friction

Amy Trainor, Ochsner's system vice president and chief information officer, said the initiative succeeds where previous attempts failed by creating direct communication channels between stakeholders who historically struggled to align.

"The ability to collaborate in that space has really, really driven conversations that probably wouldn't have happened over the years because the right people wouldn't know who to connect with," Trainor told RevCycle Management.

Recent research from Zelis found that one in five providers cite friction in payer relationships as a top organizational challenge, with 17 percent of payers reporting the same issue. Prior authorization delays specifically emerged as a major friction point for 37 percent of payers and 42 percent of providers. Yet fewer than half of both groups actually collaborate on cost and quality data.

The CMS initiative addresses this gap through a Slack channel where participating organizations can share ideas and identify collaboration partners in real time. This approach has accelerated both API implementation and process improvements.

Creating accountability through regulation

Trainor emphasized that regulatory mandates provide the accountability the industry has lacked for decades. While Health Level Seven International's Fast Healthcare Interoperability Resources (FHIR) standards have existed for over a decade, organizations had little incentive to invest in implementation.

"The piece that I find to be moving it faster is the accountability," Trainor said. "While the technology may have existed for a lot of this, there weren't any mandates or requirements for people to participate."

Ochsner has invested in prior authorization improvements over the past four years, achieving electronic processing rates of 30 percent for Humana authorizations, 28 percent for UnitedHealthcare, and 18 percent for Louisiana Blue. The health system uses Epic's payer platform, which leverages FHIR for interoperable data exchange.

New CMS regulations will require payers and their third-party vendors to use FHIR-based APIs by early 2027, covering 50 to 60 percent of Ochsner's prior authorizations immediately. Trainor expects electronic adoption rates to reach 80 percent once the APIs are fully operational.

The path forward

Trainor sees artificial intelligence as the next frontier for streamlining prior authorizations. Agentic AI could identify relevant clinical information and package it for transmission to payers, further reducing processing time. Electronic prior authorizations already save providers an average of 14 minutes per transaction, according to CAQH Index data.

For Ochsner, the ultimate goal is reducing wait times for patients facing serious diagnoses. "You have a cancer diagnosis; we're going to put your port in tomorrow. Does that work for you? It just feels different and more right," Trainor said.

These details were first reported by Jacqueline LaPointe for RevCycle Management.