Build a better authorization process
A practical operating checklist for clinics and revenue cycle teams.
Record the applicable payer rule
Confirm the specific plan, service, clinical criteria and submission channel. Keep clinical records in your approved system.
Track receipt and follow-up
CMS-0057-F sets 72-hour expedited and seven-calendar-day standard decision timeframes for impacted payers, excluding FFE QHP issuers from these timeframes. The rule’s scope is non-drug services.
Use denial reasons to improve intake
Review the stated reason with the clinical team. The rule’s API requirements generally begin in 2027; do not assume an API is already available for every payer.
This operational checklist does not submit an authorization or establish coverage. Payer and state requirements can differ.
Checked against the linked sources in September 2026. Not yet reviewed by a named clinician or billing professional; that review is planned and will be shown here when complete.
Open provider programs