CMS Launches 6-Year Technology-Enabled Prior Authorization Pilot Program
The Centers for Medicare & Medicaid Services (CMS) announced on June 27, 2025, the rollout of a 6-year technology-enabled prior authorization program pilot. The Wasteful and Inappropriate Service Reduction Model pilot will partner CMS with third-party entities to implement a technology-based prior authorization program for specific services delivered to patients with traditional fee-for-service Medicare.
Under this regionally based model, participating providers will have the option to either submit prior authorization requests for selected items and services or have their post-service claims subjected to pre-payment medical review. This approach aims to leverage technology to streamline the prior authorization process, potentially reducing administrative burdens on healthcare providers while ensuring appropriate use of Medicare services.
The CMS initiative reflects a broader effort to utilize technology in improving healthcare delivery and reducing unnecessary costs. By providing healthcare providers with the choice between prior authorization and pre-payment medical review, the program seeks to balance the need for efficient service delivery with the necessity of ensuring that Medicare services are used appropriately.
This development is part of a larger landscape of healthcare technology initiatives. Other recent developments include the FDA’s release of a software patch to address cybersecurity vulnerabilities in certain patient monitors and various agency advisories on cybersecurity threats and the use of artificial intelligence in healthcare.
As healthcare continues to evolve with technological advancements, initiatives like the CMS prior authorization pilot program are likely to play a significant role in shaping the future of healthcare delivery and administration.
