Closing the Last-Mile Interoperability Gap in Healthcare Operations

Prior authorization is one of the clearest examples of the distance between interoperability on paper and interoperability in practice. According to the 2024 CAQH Index, only 35 percent of medical prior authorizations were conducted through the fully electronic standard transaction. The rest moved through web portals or entirely manual channels: phone, mail, fax, and email.

Physicians describe the same reality. In the AMA’s 2024 prior authorization survey, physicians reported the phone as the most commonly used method for completing prior authorizations, and only 23 percent said their EHR system offers electronic prior authorization for prescription medications.

The burden shows up in staff time. CAQH found that providers spend an average of 24 minutes conducting a prior authorization by phone, fax, or email and 16 minutes through a health plan portal—the most time spent on any administrative transaction conducted through a portal.

Manual work is expensive at scale. The 2024 CAQH Index estimated that the medical and dental industries together have a $20 billion annual opportunity to reduce costs by moving from manual to automated administrative workflows.

For prior authorization alone, CAQH estimated a $515 million cost savings opportunity for the medical industry and an average time savings of 14 minutes per transaction for medical providers with full electronic adoption.

The less visible cost is in what manual work displaces. Every minute spent re-entering information into a portal or waiting on hold for status is a minute not spent identifying documentation gaps, preparing a stronger request, or following up on a case that is about to stall.

The gap persists for structural reasons. Health systems operate multiple clinical and financial systems—often more than one EHR across departments or acquired facilities, along with specialty systems such as oncology information systems, scheduling, billing, and clearinghouses. Each payer has its own portal, its own requirements, and its own status conventions.

Standards exist, but adoption is uneven, and standards alone do not carry work from one system to another. Someone still has to determine which information a task needs, retrieve it from the right source, put it in the right format, and return the result to the place where the next person will look for it.

In most organizations, that someone is a staff member with several browser tabs open. The human becomes the integration layer, and the cost of that arrangement is measured in time, errors, and burnout.

The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) is the most significant federal effort yet to modernize this work. For impacted payers—including Medicare Advantage organizations, state Medicaid and CHIP programs, and qualified health plan issuers on the federal exchanges—it requires prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests, along with specific reasons for denials, beginning January 1, 2026.

Beginning January 1, 2027, those payers must implement HL7 FHIR-based APIs, including a Prior Authorization API that supports electronic requests and responses, a Provider Access API, and a Payer-to-Payer API.

These requirements will make more data available electronically. They will not, by themselves, connect that data to the workflows inside a health system. Providers still need a way to bring payer responses, policy requirements, and status updates into the systems where their teams work, and to send complete, well-prepared requests back out.

Connectivity also introduces concentration risk. In February 2024, a ransomware attack on Change Healthcare, one of the country’s largest healthcare clearinghouses, disrupted claims processing, eligibility checks, and prior authorization workflows for providers across the country. The HHS Office for Civil Rights has since reported that the breach affected approximately 192.7 million individuals.

The lesson is not to avoid integration. It is to design it carefully: understand which systems sit in the critical path, protect the data that moves between them, and maintain the ability to continue work when one connection is unavailable.

A well-designed connection layer gives a health system more control, not less. It makes data flows visible, limits each connection to the information it needs, and keeps completed work in systems the organization owns.

Health systems should not have to replace their EHR or add another portal to close the last mile. The more practical approach is to connect the systems already in place and let information move to where the work happens.

Just Connect™ links Just Healthcare products with Epic, Cerner, Aria, and other EHRs through available APIs, including FHIR, connects with Availity and payer portals for eligibility and status, and accepts secure document upload for anything that lives outside the EHR. Completed work—prepared notes, letters, and status—returns to the place the team already works.

Gravity™ builds on that foundation for organizations that want a complete operating view. It brings EHR, scheduling, billing, and Just Healthcare products into one workflow, assigns each task an owner and a due date, and shows the progress of every case in real time.

The aim is simple: fewer handoffs, fewer re-entries, fewer status calls, and more time for the work that requires human judgment.