Epic has launched a tool that lets clinicians instantly check inside the EHR whether an insurer requires prior authorization for a treatment eliminating the need for phone calls, faxes, or hunting through payer portals (Epic). The API, called Coverage Requirements Discovery (CRD), is live at four health systems (Ochsner Health, Froedtert ThedaCare, Denver Health, Summit Health) checking requirements with UnitedHealthcare, Aetna, and Network Health. Sixteen other payers are testing. This project is nearly five months ahead of CMS's January 2027 deadline requiring most Medicare Advantage, Medicaid, and ACA marketplace insurers to implement similar APIs (TechTarget).
What This Means for GI Practices
Real-time coverage checks at scheduling could meaningfully cut the administrative drag around endoscopy prior authorization with a few caveats:
- Epic-only, early stage. Only practices on Epic benefit, and only with the handful of payers currently connected.
- Solves discovery, not documentation. CRD tells you whether prior auth is needed. It doesn't submit the request or supply clinical justification. ASGE's own documentation guidance for endoscopy still applies regardless of how fast the check happens.
- Doesn't touch denial rates. Faster discovery doesn't mean faster or more favorable decisions. Recent KFF data still shows meaningful denials and high appeal-overturn rates.