Epic has introduced real-time checks for payer requirements, while California lawmakers consider longer-lasting approvals. New research found no association between existing EHR-based authorization capabilities and lower reported physician burden.
Epic calls the new interface Coverage Requirements Discovery. Clinicians and staff can use it when placing an order or scheduling care to check whether a participating payer requires prior authorization. Ochsner Health, Froedtert ThedaCare Health, Denver Health and Summit Health launched the function with UnitedHealthcare, Aetna and Network Health. Epic says 16 additional payers are testing it.
Epic and participating systems expect the interface to reduce manual searches and allow practices to begin required authorization work sooner. However, the available evidence does not show that the function provides instant approval or eliminates documentation, denials, appeals and follow-up work.
A national study published in the Journal of General Internal Medicine underscores that distinction. Researchers analyzed self-reported responses from 8,419 U.S. family physicians who completed the American Board of Family Medicine’s 2024 Continuing Certification Questionnaire. Fifty-four percent reported substantial prior-authorization effort, while 41% reported at least three hours of after-hours documentation per evening. Overall, 77% experienced at least one of three substantial burdens: prior authorization, after-hours documentation, or efforts to obtain outside health information. Fifteen percent experienced all three.
Researchers found no association between physicians’ reported ability to complete prior-authorization requirements through their outpatient EHR and lower prior-authorization burden. The authors concluded that practices may need broader payer alignment, direct interoperability, staff support and workflow redesign—not digitization alone. The study did not evaluate Epic’s newly launched interface, so its findings provide context rather than evidence about the new function’s performance.
California lawmakers are considering a separate approach. As amended August 21, AB 539 would require an approved prior authorization requested by an in-network provider to remain valid for at least one year from approval, or for a shorter period requested by the treating provider. The bill would allow plans and insurers to authorize periods longer than one year.
The approval would generally expire if the patient’s coverage with the issuing plan or insurer ended, subject to applicable continuity-of-care laws. Prescription-drug approvals could not exceed validity periods established under state or federal law.
Supporters say the bill could reduce repeat requests and treatment interruptions. Opponents have raised concerns about clinical reassessment, unnecessary utilization, and the scope of individual authorizations. The bill remains pending and has not become law.
Scripps Health and UC San Diego Health use Epic platforms. Epic did not identify either organization among the first four participating systems, and PNN has not independently confirmed whether either plans to activate the interface. San Diego physicians should watch which insurers participate, whether independent and affiliated practices receive access, and whether health systems measure staff time, decision speed, denial rates, and patient delay in assessing the value of Epic Coverage Requirements Discovery.
Technology may identify requirements earlier, and AB 539 could reduce repeat requests after approval. Neither approach, on its own, addresses every step that consumes physician and staff time.