U.S. Insurance Approval Changes
- health insurers, including unitedhealthcare, CVS Health, Cigna, Humana, Elevance Health and Blue Cross Blue Shield plans, have pledged to accelerate and simplify prior authorization procedures.
- Prior authorization, the process where providers must secure approval from an insurer before certain treatments or services, has drawn criticism for causing delays in care, denials, and increased...
- The changes, impacting commercial, Medicare, and Medicaid plans, are projected to benefit 257 million Americans.
U.S. health insurers are overhauling their prior authorization processes, promising faster care access for millions. Major players like UnitedHealthcare and CVS health are taking decisive action to cut red tape, reduce claim delays, and ease the burden on both patients and providers. By 2027, expect standardized electronic submissions and streamlined approvals as a common practice.This initiative, likely to impact over 250 million Americans, signals a critically importent shift in how healthcare services are authorized. These changes are anticipated to reduce administrative workloads, especially for practices still bogged down by paper-based submissions. News Directory 3 is closely watching these updates. Discover what’s next in this evolving sector.
Major Health Insurers to Streamline Prior Authorization Processes
Updated June 23, 2025
Several leading U.S. health insurers, including unitedhealthcare, CVS Health, Cigna, Humana, Elevance Health and Blue Cross Blue Shield plans, have pledged to accelerate and simplify prior authorization procedures. This move aims to alleviate a significant pain point for both patients and health care providers.
Prior authorization, the process where providers must secure approval from an insurer before certain treatments or services, has drawn criticism for causing delays in care, denials, and increased physician burnout. Insurers maintain it ensures medical necessity and cost control.
The changes, impacting commercial, Medicare, and Medicaid plans, are projected to benefit 257 million Americans. The effort builds upon existing company initiatives to streamline prior authorization. A key component is establishing a common electronic standard for submitting requests by 2027, wiht a goal of 80% real-time responses for electronic submissions with complete documentation.
Individual plans also commit to reducing the number of services requiring prior authorization by 2026. This modernization seeks to ease the administrative workload for doctors and hospitals, many of whom still rely on manual, paper-based submissions.
Steve Nelson, president of Aetna, CVS’ insurer, stated, “The American health care system must work better for people, and we will improve it