The 2027 prior authorisation date: what to do now

Submit, deny, resubmit, call. Prior authorisation is the textbook send-back loop, and a US rule is about to change the other side of it. This is a practical summary from secondary sources. It isn’t legal advice, and you should check the CMS text before you act on any of it.

The dates

• Decision clocks of 72 hours and 7 days began in 2026 for the payers the rule covers.
• Data connections are due by 1 January 2027.

What to do now

• List which of your payers the rule covers, and which it doesn’t. Your own mix decides how much changes.
• Count your last 50 authorisations: how many were sent back, and why.
• Name one person who owns every open authorisation, and give them one list.
• Keep the clinical facts each payer asks for on the record, not in a portal or an inbox.
• Tell the patient before the visit if cover isn’t confirmed.

What we expect next

This part is our opinion. Insurers are automating their side of every claim, so clinics will soon be answering agents, not fax machines. Clean evidence on the record will count for more than it does today.

Where Sovica fits

Sovica warns about authorisation before you treat, tracks it as one job, and keeps it on the Next Steps list until it’s done or sitting with a named person.