More than 50 health plans are committed to simplifying prior authorization

Payer advocacy group AHIP announced on Monday that dozens of health insurers have made a series of commitments to improve and reduce prior authorization. This practice is often a point of argument with providers who believe it increases administrative burden and delays care.

A total of 53 insurers have committed to simplifying prior authorization, including UnitedHealthCare, Aetna, Cigna, several Blues plans and numerous regional insurers. Payers provide commercial insurance, Medicare benefits and Medicaid custodial care.

“The healthcare system remains broken and burdened by outdated manual processes, causing frustration between patients and providers. Health programs are voluntarily committed to delivering a more seamless patient experience and enabling providers to focus on patient care while also helping modernize the system,” Mike Tuffin Tuffin Tuffin Tuffin Anip of Anehip of Anemand of Aneance of Aneance.

According to AHIP, the insurance company has committed to six lawsuits:

• Standardized Electronic Pre-authorization: Health plans will develop standardized data and submission requirements for electronic pre-authorization to support faster turnaround times. They plan to achieve this by January 1, 2027.
• Reduce scope of claims to comply with prior authorization: Insurers will reduce the prior authorization requirements for certain claims, which will depend on the markets each plan serves. These reductions are expected to begin on January 1, 2026.
• Ensure continuity of care when patients switch plans: When patients switch insurance plans during treatment, their new insurer must respect the existing authorization for similar network services within 90 days to ensure continuity of care and prevent delays. This will begin on January 1, 2026.
• Improve communication and transparency in determination: Insurers promise to provide a clear explanation of previous authorization determinations and appeal information. This will provide comprehensive insurance and commercial insurance by January 1, 2026.
• Expanded Real-time Response: In 2027, insurance companies expect at least 80% of electronic authorization approvals to be answered in real time.
• Provide medical review of unapproved requests: All unapproved requests based on clinical reasons will be reviewed by a medical professional. This has worked.

“These measurable commitments – addressing timeliness, scope and streamlining improvements – mark a meaningful step in our work together to create a better health system,” Kim Keck, president and CEO of the Blue Cross Blue Shield Association, said in a statement. “This is an important foundation for solving bigger problems, at a time when technology and interoperability can bring real improvements to the patient experience.”

Historically, previous authorizations have been the source of friction between payers and providers. A recent survey by the American Medical Association found that 93% of providers believed that previous authorization delayed access to necessary care, while 89% said this would increase physician burnout. Meanwhile, the payer believes that prior authorizations must be made to reduce costs and ensure that care is appropriate.

The American Medical Association supports previous authorization reforms and specifically calls on federal lawmakers to continue these reforms.

“For the past decade, the American Medical Association has been a leadership voice calling for advance authorization reform, so we commend Secretary Kennedy, Executive and Deputy Chief Executive Klomp for convening leadership in the health insurance industry to address the urgent need for advance authorization reform. The proposal announced today announced today is Boby Boby’s society and has put our medical committee at risk of our doctors,” Mukaby Muke Muke Muke Muke Muke.

“However, patients and doctors will need details to show that the latest insurer commitments will generate substantial actions to bring immediate and meaningful changes, break unnecessary barriers, and make medical decisions between patients and doctors,” Mukkamala added.

Leaders of the startups prior authorization noted that these commitments may have meaningful impact, but require transparency and action.

“The next step is clarity: which services still require prior authorization, how to make decisions and whether payers are delivering measurable results,” Dr. Jeremy Friese, founder and CEO of Humata Health, said in an email. “We also know that technologies to achieve real-time decisions are already there. To ensure that this commitment leads to real-time changes by 2027, we need to start right away: There are clear goals, shared accountability, and beliefs that can get better, faster, and faster access to care.”

Photo: Piotrekswat, Getty Images