2026 Prior Authorization and Interoperability Readiness Benchmark

The document is a technical report detailing the 2026 Prior Authorization & Interoperability Readiness Benchmark (PAIR). It outlines the operational realities facing payer-provider technology leaders as they prepare for HIMSS26, emphasizing the importance of workflow reliability, API readiness, and governance accountability in achieving interoperability and prior authorization modernization. The report highlights the urgency for organizations to transition from planning to operationalizing these processes due to regulatory deadlines set by the CMS and ONC. It presents a framework for assessing operational readiness across various stakeholders in the healthcare ecosystem, focusing on five key pillars: workflow operationalization, interoperability usability, API reliability, governance accountability, and compliance readiness. The report also discusses the implications of operational fragility and the complexities of privacy and governance as organizations increase connectivity and automate workflows. The findings aim to provide actionable guidance for organizations to demonstrate their operational capabilities in a rapidly evolving healthcare landscape.