This year’s Open Epic Conference put a spotlight on interoperability — and for good reason. The Epic team shared their continued commitment to TEFCA and laid out their vision for the growth of HL7® FHIR® standards, which will increasingly shape how health systems, payers, and technology vendors exchange data.
For revenue cycle leaders, the conversations around prior authorization were particularly noteworthy. With CMS’s CMS-0057-F rule coming into effect next year, health plans will be required to adopt electronic prior authorization via FHIR-based APIs, and Epic is building capabilities to align with these new requirements.
“Epic’s interoperability roadmap shows strong progress in advancing critical standards for healthcare and prior authorization. What stood out to me is that even as the industry evolves, Janus’ expertise in payer connectivity, EHR integration, and Clinical Bundling automation continues to set the pace and deliver high value for health systems,” said Senior Product Manager, Alex Dawson.
Epic’s Roadmap for Coverage Burden Reduction
Epic devoted significant attention to HL7’s Coverage Burden Reduction APIs. These include Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS). Collectively, these APIs are designed to streamline how health systems identify when prior auth is needed, gather required clinical documentation, and submit requests electronically.
- Coverage Requirements Discovery (CRD): Epic outlined plans to embed CRD into workflows at the point of scheduling and during patient visits, helping providers surface payer requirements earlier in the process. This enhancement, however, relies heavily on accurate insurance mapping within the health system’s EHR.
- Documentation Templates and Rules (DTR): While Epic confirmed DTR is on the roadmap, its release timeline remains unclear. Epic hinted at future AI-driven functionality to help complete payer questionnaires, but details were sparse.
- Prior Authorization Support (PAS): Epic emphasized their goal of “touchless” prior authorization — automatically triggering submissions when CRD identifies a requirement. Still, adoption will be limited to payers integrated via Epic Tapestry or Epic Payer Platform (EPP), leaving gaps for many health plans outside those ecosystems.
The Opportunity and the Challenge
Epic’s commitment to advancing FHIR-based standards is a step forward for the industry. Yet, the limitations are clear: functionality depends on payer adoption, health system module upgrades (like EMPA), and accurate data mapping. Many payers remain hesitant to connect directly through Epic, and adoption of Epic’s EPP functionality has been slower than expected.
For health systems, this means prior authorization automation will remain a patchwork unless solutions extend beyond Epic’s walls.
How Janus Health Bridges the Gap
At Janus Health, we see this as both a challenge and an opportunity. Our Prior Authorization solution is designed to work seamlessly alongside evolving standards like Coverage Burden Reduction APIs while addressing the gaps that still exist in payer connectivity and automation.
Specifically, we are:
- Aligning with FHIR standards: Our solutions are intentionally built to integrate with Coverage Burden Reduction APIs as they become available.
- Expanding automation beyond Epic’s limitations: By deeply understanding both payer requirements and provider workflows, we ensure automation isn’t restricted to a narrow subset of payers or modules.
- Introducing Clinical Bundling: Soon, Janus Health will release new functionality to automate one of the most complex and time-consuming aspects of prior authorization — assembling and submitting complete clinical documentation packages reliably and at scale.
Looking Ahead
Interoperability progress at the national level is encouraging, and Epic’s continued leadership in this space is important. But the reality is that prior authorization remains a burden until both providers and payers are aligned on efficient, automated processes.
That’s where Janus Health comes in: by marrying a deep understanding of revenue cycle operations with advanced automation and interoperability, we’re ensuring our customers stay ahead of the curve — not just compliant, but optimized.