Epic Systems is collaborating with healthcare providers and a growing number of health insurers to update the process of prior authorization, a contentious procedure where insurers assess hospital admissions and medications. In this image, Epic’s founder and CEO Judy Faulkner speaks at the annual Forbes Healthcare Summit on December 4, 2025, at NYU Langone Health in New York City.
Jamel Toppin
Epic Systems is actively engaging with medical professionals and a rising number of health insurance companies to revamp the prior authorization process, which involves insurers evaluating hospital admissions and medications.
During its annual users group meeting held this week at its headquarters in Verona, Wisconsin, Epic announced its success in assisting doctors and hospitals throughout the United States to “implement real-time prior authorization checks” with insurers such as UnitedHealth Group’s United Healthcare and CVS Health’s Aetna. This is achieved using a new industry-standard API called Coverage Requirements Discovery (CRD). Epic also noted that an additional 16 insurers are currently testing its system.
According to a statement released by Epic on Monday, “Clinicians and staff can easily check prior authorization requirements in Epic when placing an order or before scheduling an appointment, eliminating the need for phone calls, faxes, or retyping information into separate insurance portals.”
This announcement from Epic comes amid widespread criticism of health insurance business practices from patients, healthcare providers, lawmakers, and regulators at both state and federal levels, who are calling for the reduction or elimination of prior authorization. An analysis by KFF last week revealed that insurers denied 12% to 18% of prior authorization requests in the previous year for Americans with Medicare Advantage, Medicaid, or individual coverage under the Affordable Care Act.
Prioritizing the implementation of electronic prior authorization has been a focus for the Centers for Medicare & Medicaid Services and the Trump administration to expedite this process in the healthcare sector.
Epic has confirmed that the first healthcare systems to adopt this new feature include Ochsner Health, Froedtert ThedaCare Health, Denver Health, and Summit Health.
With its 83-year-old founder Judy Faulkner at the helm for 47 years, Epic is renowned for its leadership in the electronic health record software industry. The company is strengthening its partnerships with health insurers and advancing into artificial intelligence within the complex and fragmented healthcare industry. Epic’s technology is utilized by 3,500 hospitals, over 71,000 clinics, and approximately 325 million patients globally.
