October 2026
By Trinidad Navarro
You can order a pizza on your phone and watch it move from “order received” to “in the oven” to “out for delivery.”
But when your doctor needs your insurer’s approval for an MRI, physical therapy, a prescription, or another service – a process called prior authorization – a simple question can be surprisingly difficult to answer: What is happening with my request?
Healthcare is more complicated than delivering a pizza. Coverage decisions require medical information and careful review. But complexity is no excuse for making patients and doctors rely on faxes, repeated phone calls, and paperwork just to find out where things stand.
Delaware is working to change that.
Starting in January 2027, new federal requirements will begin taking effect for electronic prior authorization of medical services other than drugs. The requirements cover Medicare Advantage, Medicaid, the Children’s Health Insurance Program and plans sold through the federal health insurance marketplace. Original Medicare, the traditional Medicare program, is not covered by these particular requirements.
This is progress. But replacing faxes with computers will not help enough if doctors still have to navigate a different system for every insurer.
Consider a doctor’s office treating patients covered by several insurers. Staff may have to use a different website for each one, enter information repeatedly and call to check whether medical notes arrived.
Delaware is bringing insurers, doctors, hospitals, and technology companies together to develop a shared way for their existing computer systems to send requests and responses securely. The goal is for a doctor’s office to use the system it already knows to reach participating insurers, rather than learn a separate process for each. Setup and testing can then be reused instead of repeated.
The work is underway. At a hands-on testing event this summer, 16 organizations exchanged thousands of test messages to check whether their systems could communicate. More recently, over 50 healthcare representatives met to prepare for January 2027. The practical work includes making sure requests reach the right insurer, missing information can be supplied, and responses get back to the doctor’s office.
The federal rules do not cover everyone. But our ambition should be a simpler process for more Delawareans over time. Most importantly, patients should be able to see whether a request was submitted, what information is missing, whether a decision has been made, and what happens next without becoming detectives for their own care.
Technology will not eliminate every disagreement over prior authorization. Insurers will still make coverage decisions, doctors will still make clinical decisions, and my department will continue holding insurers accountable to Delaware consumers.
Health plans and healthcare organizations that have not joined this work should engage now. Consumers having trouble getting answers about an insurance authorization can contact my department for help.
If we can track a pizza across town, patients should be able to see what is happening with something far more important: their healthcare.
Trinidad Navarro has served as Delaware Insurance Commissioner since 2016 working to ensure insurance affordability and availability, as well as the accountability of insurance companies. He is a member of the National Association of Insurance Commissioners and is chair of the National Antifraud Taskforce.