Prior Authorization Changes: 50+ Health Plans Simplify Process
- More than 50 health insurance providers, including UnitedHealthcare, Aetna, and Cigna, have committed to improving and reducing the burden of prior authorization, according to AHIP.
- The insurers, spanning commercial, Medicare Advantage and Medicaid managed care, aim to standardize electronic prior authorization processes by Jan.
- To ensure continuous care,insurers will honor existing prior authorizations for similar in-network services for 90 days when patients change plans,beginning Jan.
Over 50 health insurance providers are streamlining prior authorization processes, promising significant changes impacting patient care. This marks a pivotal moment for healthcare, with key reforms including standardized electronic submissions and a reduced scope of claims requiring prior authorization, slated to roll out by 2027.Insurers will also honor existing authorizations for 90 days when patients switch plans. The American Medical Association and other experts are advocating for openness and measurable results. Read how UnitedHealthcare, Aetna, and Cigna are leading the charge. For an even deeper dive, look to News Directory 3 for the latest developments. Discover what’s next …
Health Insurers Pledge Prior Authorization reform for Streamlined Care
More than 50 health insurance providers, including UnitedHealthcare, Aetna, and Cigna, have committed to improving and reducing the burden of prior authorization, according to AHIP. The move addresses long-standing concerns from health care providers about administrative delays and obstacles to patient care.
The insurers, spanning commercial, Medicare Advantage and Medicaid managed care, aim to standardize electronic prior authorization processes by Jan. 1, 2027. They also plan to narrow the scope of claims requiring prior authorization starting Jan. 1, 2026, varying by plan and market.
To ensure continuous care,insurers will honor existing prior authorizations for similar in-network services for 90 days when patients change plans,beginning Jan. 1, 2026. Clear explanations of prior authorization decisions and appeal information will also be available by that date for fully insured and commercial coverage.
By 2027, the insurers anticipate that at least 80% of electronic prior authorization approvals will receive real-time responses. Medical professionals will review all clinically-denied requests,a practice already in effect.
Mike Tuffin, president and CEO of AHIP, said health plans are voluntarily committing to a more seamless patient experience, enabling providers to focus on care and modernize the system.
“The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike,” Tuffin said.
Kim Keck, president and CEO of Blue Cross Blue shield Association, emphasized the importance of thes commitments in creating a better health system.
“These measurable commitments – addressing improvements like timeliness, scope and streamlining – mark a meaningful step forward in our work together to create a better system of health,” Keck said.
The American Medical Association (AMA) has voiced support for the reforms, with AMA President Dr. Bobby Mukkamala calling on insurers to provide specifics demonstrating substantive actions and immediate changes.
“the proposals announced today would help right-size and streamline a process that is harming our patients daily,” Mukkamala said. “However, patients and physicians will need specifics demonstrating that the latest insurer pledge will yield substantive actions to bring immediate and meaningful changes.”
Dr. Jeremy Friese, founder and CEO of Humata health, a prior authorization startup, stressed the need for transparency and measurable results.
“The most crucial next step is clarity: which services still require prior authorization, how decisions are being made, and whether payers are delivering measurable results,” Friese said.
What’s next
Industry stakeholders will be watching closely to see how these commitments translate into tangible improvements in the prior authorization process,with a focus on transparency,accountability,and faster access to care for patients.