How to do a prior authorization in 30 seconds.

Dear Partners and Friends,

Most prior authorizations in oncology still go out by fax. Most of the time a fax PA takes is not the payer. It is staff finding the right form, pulling the chart, and re-typing the same diagnosis onto it. That part can take 30 seconds.

Fax prior authorization, automated: two selections and one review

Wavera's Prior Authorization Co-Pilot automates the fax workflow end to end:

• You select the patient and the service.
• Wavera matches the payer: whether PA is required, the payer or delegated reviewer, its fax line, and its form.
• Luna drafts the request from chart context: diagnosis, biomarkers, performance status, prior therapy, and guideline rationale, each tied to its source.
• Our form-filling engine completes the payer's fax form and assembles the fax packet with the supporting documents.
• You review, edit, and fax. Nothing leaves the practice without your approval, and the fax status is tracked.

The payer's turnaround and the clinical judgment stay the same. The searching, copying, re-typing, and fax-machine work go away.

What CMS-0057-F changes

• Who: Medicare Advantage, Medicaid and CHIP, and Exchange (QHP) plans. Not employer or most commercial plans.
• January 2026: decisions within 72 hours (expedited) or 7 days (standard) for MA, Medicaid, and CHIP; a specific reason for every denial; public PA metrics.
• January 2027: payer Prior Authorization APIs, so requirements, submission, and decisions can be exchanged electronically.
• Not covered: drugs. Much of oncology PA volume, including chemotherapy, sits outside the rule.

Until every payer has an API, fax and portals stay. The work that matters is building the request once, whatever the channel.

Why fax is not going away yet

Fax is still the main channel. AHIP reports that about 45% of the prior authorizations health plans receive arrive manually, usually by fax. In the 2025 CAQH Index, electronic adoption for medical prior authorization reached 40%, up from 31% in the 2023 Index.

Commercial plans are on a voluntary timeline. CMS-0057-F does not reach employer and most commercial coverage. For those plans, the main driver is the June 2025 industry pledge: fewer services requiring PA, a standard electronic submission, and real-time answers for 80% of complete electronic requests in 2027. In 2026, AHIP reported an 11% cut in PA volume. These are self-reported figures, not audited ones, and physician groups say they have not felt much change yet.

The APIs are still being built. In the 2025 CAQH Index, 63% of medical plans were still developing their FHIR prior authorization APIs, and only 20% of providers had begun implementation.

Oncology PA is often delegated. Many plans hand oncology, radiation oncology, and imaging review to benefit managers such as eviCore, Carelon, Evolent, and OncoHealth. Each delegate brings its own criteria, portal, and fax line, and its guideline, not the health plan's, governs the decision. Delegations also change: Blue Cross Blue Shield of Michigan, for example, moved radiation oncology review to OncoHealth on September 1, 2026. A health plan publishing an API does not mean its delegated reviewer accepts requests through it.

Drugs follow a different path. Pharmacy-benefit drugs already have an electronic standard (NCPDP SCRIPT ePA) that is widely used. Infused therapies billed under the medical benefit, where much of chemotherapy sits, are excluded from CMS-0057-F and still rely mostly on forms, portals, and fax.

For the next few years, a practice will work across all of these at once: fax for many payers and delegates, portals for some, and APIs as they come online. That is why we started the Co-Pilot with fax, and why the request it builds does not depend on the channel.

Warm regards,

Wei Yang, M.D.
Co-Founder and CEO, Wavera Health