The federal rule that takes effect on January 1, 2027 requires every Medicare Advantage, Medicaid managed care, and ACA exchange plan to expose a standard prior-authorization interface that any provider EHR or clearinghouse can reach. Most plans are scoping the response right now. The choice in front of you is essentially:
- Build it internally with a multi-quarter program and an in-house clinical-content team.
- Layer it on top of an existing utilization-management platform tied to a licensed third-party content library.
- Buy a CMS-aligned platform that ships the standard interface ready-to-route.
AuthMatch is the third option. It is engineered to compress what looks like a multi-quarter integration into a vendor onboarding.
No third-party content licensing
AuthMatch does not bundle or repackage licensed third-party clinical content. There is no per-seat content fee tied to platform usage, no annual content renewal in the budget, and no risk of an audit finding driven by content-license drift. Organizations that already license a third-party library separately can upload their own copies into a tenant-scoped library — under their own license, not ours.
One endpoint reaches every routing partner
The federal rule names a single standard interface. Every clearinghouse and provider EHR is integrating to it. AuthMatch ships that interface in production, ready for your routing partner to point at — your IT team adds one configuration line on their side and your providers connect through it.
The platform maintains the regulatory corpus
CMS publishes coverage rules. Federal contractors publish jurisdictional coverage. The US Preventive Services Task Force publishes preventive recommendations. AuthMatch ingests every public-domain source on a continuous schedule — automatically, with the row counts and refresh timestamps published live. No internal team maintaining a content stack on the operator’s side.
Timeline to value
A working sandbox with synthetic case data inside one business week. The first production-routed claim follows once your contracting and the routing-partner handshake complete — a procurement timeline, not an integration timeline.
What your team has to do
One signed Business Associate Agreement. One administrator named to manage user access. One IT configuration line on your routing-partner side. Your existing clinical and compliance teams continue their current work — AuthMatch sits where the prior-auth pipeline already lives, not as a parallel system.
Vendor risk posture
Deliberately narrow scope: CMS-regulated lines only, public-domain content only, no third-party redistribution. That keeps the failure surface small. The platform’s regulatory positioning is published in the open at /policy-library for any reviewer to inspect — there is no proprietary content claim to defend.
We are deliberately not a comprehensive utilization-management replacement.
AuthMatch covers prior-authorization workflows where CMS publishes the controlling rule (NCD, LCD, MAC Article). Inpatient admission, level-of-care, and length-of-stay benchmarks remain with proprietary third-party libraries. Behavioral-health acuity beyond publicly-published surfaces is also out of scope. For commercial-plan medical-necessity criteria not present in the CMS corpus, your team uploads its own.
That deliberate narrowness is the value to the procurement. It keeps the contract clean, the licensing flat, the scope auditable, and the vendor-failure surface predictable.
Schedule a 30-minute business-case review. We bring the procurement-friendly numbers as a working spreadsheet, a synthetic round-trip you can show your team, and the BAA and pilot-scoping templates. You bring your evaluation criteria.
Corpus 3,242 rows · most-recent refresh 6 hours ago · verify on /policy-library