Major health insurance companies are working to standardize prior authorization requirements as part of an effort to simplify paperwork for providers and reduce delays in care.
Two leading industry organizations, AHIP and Blue Cross Blue Shield Association, said Friday that major health plans are making significant progress in their efforts to adopt a standardized approach for providers submitting electronic prior authorization requests for most health services.
According to AHIP and BCBSA, this standardized approach will be used for medical services that generally require prior authorization, such as orthopedic surgery and imaging services such as CT scans and MRIs. These services span commercial insurance, Medicare Advantage, and Medicaid managed care. Additional services will be added over time.
The initiative is part of an industry-wide effort announced last summer to smooth the pre-certification process and improve transparency and communication around decisions. As part of that effort, working with the Department of Health and Human Services and the Centers for Medicare and Medicaid Services, the insurer said it will show significant progress toward the goal by early 2026. About 50 plans have signed on to the initiative, including all six of the largest publicly traded insurance conglomerates: Elevance Health, Centene, Cigna, CVS Health’s Aetna, Humana and United Healthcare.
Key changes include reducing the number of services subject to pre-authorization and implementing solutions to facilitate electronic pre-authorization, with plans to establish a framework for both payers and providers by January 1, 2027.
So far, major health plans have reduced prior authorizations for a range of services by 11% in the approximately nine months since this pledge was made. AHIP and BCBSA reported earlier this month that this equates to a decrease of 6.5 million prior authorization requests for patients. Specifically, the cut to Medicare Advantage was 15%, according to the group’s report.
“As more providers adopt electronic prior authorization, this standardized approach means faster answers for patients, a more consistent experience for providers, and less friction for everyone,” Mike Tuffin, president and CEO of AHIP, said in a statement.
UnitedHealthcare, the insurance division of UnitedHealth Group, said it has standardized the documentation process for more than half of its preauthorization volumes and expects 70% of preauthorization requests to be part of this standardized process by the end of this year.
“Today’s announcement is another step in our journey to modernize healthcare, making prior authorization faster, easier and more efficient,” UnitedHealthcare CEO Tim Noel said in a statement. “These changes will help healthcare providers and patients save time and money, and set the stage for a more seamless electronic experience. Our efforts continue as we pursue a modern, touchless authentication process.”
Aetna says it has standardized 88% of its prior authorization volume and touts it as having “the lowest number of medical services requiring prior authorization of any health plan in the nation.”
“Aetna is proud to deliver better, faster care to those who need it, and most importantly, to those who need it,” Aetna President Steve Nelson said in a statement. “Prior authorization should enable treatment, not delay it. We are modernizing our processes with speed, transparency, and clinical judgment to benefit everyone we serve.”
The health insurer said its efforts resulted in more than 95% of eligible prior authorizations being approved within 24 hours, 83% processed in real-time, exceeding AHIP’s 2027 industry goal of 80%, and automation and digital tools reducing more than 1 million calls to providers.
Aetna also noted its efforts to integrate medical and pharmacy decisions into a single symptom-specific review and launch a new bundle pre-approval program that includes comprehensive musculoskeletal products, building on the initial cancer bundle.
Cigna Group said it plans to standardize more than 70% of the previous authorizations for medical services by the end of 2026, with additional services to be added over time. The health plan said it has already reduced the amount of medical prior authorizations by about 15%.
“We want patients to get the care they need, when they need it, and we want to free up physicians and their teams to focus on patients, not paperwork,” Amy Fruster, MD, Cigna Group chief medical officer, said in a statement. “We are leading much-needed improvements to make prior authorization clearer and more consistent. While this is an important advance, we recognize there is still much work to do as we continue our commitment to providing a simpler, more personalized healthcare experience for everyone we serve.”
