Epic Methods is working with medical care suppliers and an growing variety of well being insurers to modernize prior authorization, the controversial means of insurers reviewing hospital admissions and medicines. On this photograph, Epic founder and chief government officer Judy Faulkner speaks on the annual Forbes Healthcare Summit December 4, 2025 at NYU Langone Well being in New York Metropolis.
Jamel Toppin
Epic Methods is working with medical care suppliers and an growing variety of well being insurers to modernize prior authorization, the method of insurers reviewing hospital admissions and medicines.
Assembly this week at its Verona, Wis., headquarters for its annual customers group assembly, the corporate mentioned it’s efficiently serving to medical doctors and hospitals throughout the U.S. “implement real-time prior authorization checks” with well being insurers together with UnitedHealth Group’s United Healthcare, the nation’s largest well being insurer, and CVS Well being’s Aetna “utilizing a brand new industry-standard API known as Protection Necessities Discovery (CRD).” Epic mentioned one other 16 well being insurers are testing its system.
“Clinicians and workers can simply test prior authorization necessities in Epic when inserting an order or earlier than scheduling an appointment, eliminating the necessity for cellphone calls, faxes, or retyping info into separate insurance coverage portals,” Epic mentioned in a press release launched Monday.
Epic’s announcement comes at a time medical insurance enterprise practices are underneath fireplace from sufferers, physicians, lawmakers and regulators at each the state and federal degree to cut back or eliminate prior authorization. Just last week, a analysis by KFF confirmed that insurers denied between 12% and 18%, roughly one in eight, of prior authorization requests final yr for People enrolled in both privatized Medicare Benefit protection for older adults, Medicaid protection for poor People or particular person protection underneath the Inexpensive Care Act, often known as Obamacare.
Nevertheless it has been a priority of the Centers for Medicare & Medicaid Companies and the Trump administration to hurry up implementation of digital prior authorization throughout the healthcare {industry}.
Epic confirmed the primary healthcare methods to implement this new function are Ochsner Well being, Froedtert ThedaCare Well being, Denver Well being and Summit Well being.
Epic, which has been led by its 83-year-old founder Judy Faulkner for 47 years and is finest recognized for its dominance within the digital well being report software program area, is forming nearer ties with medical insurance firms whereas pushing deeper into AI in a healthcare {industry} recognized for its complexities, fragmentation and shopper frustration. Epic’s expertise is already utilized by 3,500 hospitals, greater than 71,000 clinics and a few 325 million sufferers worldwide.
