UnitedHealthcare, Aetna, Cigna tout progress to standardize prior authorization

 Major health insurers are advancing efforts to standardize prior authorization requirements as part of an effort to simplify paperwork for providers and reduce delays in medical care.

Two of the industry's leading organizations, AHIP and the Blue Cross Blue Shield Association, said Friday that leading health plans are making significant progress in their efforts to adopt a standardized approach for providers submitting electronic prior authorization requests for the majority of medical services.

The standardized approach will be used for medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services, including CT scans and MRIs, AHIP and BCBSA said. These services span commercial coverage, Medicare Advantage and Medicaid managed care. Additional services will be added over time. 

This initiative is part of an industry-wide commitment announced last summer to smooth out the prior auth process and also improve transparency and communication around determinations. As part of that commitment, in alignment with the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, insurers said they would demonstrate notable progress toward the goals by the beginning of 2026. About 50 plans 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 UnitedHealthcare.

Key changes included reducing the number of services subject to prior authorization, as well as implementing solutions to promote electronic prior auth, with plans to establish a framework for both payers and providers by Jan. 1, 2027.

So far, leading health plans reduced prior authorizations for an array of services by 11% in the roughly nine months since the pledge was made. This equates to 6.5 million fewer prior auth requests for patients, AHIP and BCBSA reported earlier this month. Reductions in Medicare Advantage specifically were 15%, according to the groups' report.

“As more providers adopt electronic prior authorization, this standardized approach will mean faster answers for patients, a more consistent experience for providers and less friction for everyone,” Mike Tuffin, AHIP President and CEO, said in a statement.

UnitedHealthcare, the insurance arm of UnitedHealth Group, said it has standardized the documentation process for more than half of its prior authorization volume with plans to have 70% of prior auth requests as part of this standardization process by the end of this year. 

“Today’s announcement is another step in our work to modernize health care, making prior authorization quicker, simpler and more efficient,” said Tim Noel, CEO of UnitedHealthcare, in a statement. “These changes help care providers and patients save time and money and set the stage for a more seamless electronic experience, and our work will continue as we pursue a modern, touchless authorization process.”

Aetna said it has standardized 88% of its prior authorization volume, touting that it maintains the "fewest medical services requiring prior authorization among national health plans."

“Aetna is proud to lead, and most importantly, to deliver better, faster care to people who need it,” said Aetna President Steve Nelson in a statement. “Prior authorization should enable care, not delay it. We’re modernizing the process with speed, transparency, and clinical judgment to benefit everyone we serve.”

The health insurer said its efforts have resulted in more than 95% of eligible prior authorizations approved within 24 hours, 83% processed in real time, exceeding AHIP’s 2027 industry commitment of 80% and more than 1 million provider calls eliminated through automation and digital tools.

Aetna also noted its efforts to integrate medical and pharmacy decisions into single, condition-specific reviews and newly launch bundled prior authorization programs, including a comprehensive musculoskeletal offering, that build on earlier cancer bundles.

The Cigna Group said it expects to standardize more than 70% of its prior authorization volume for medical services by the end of 2026, with additional services added on a rolling basis. The health plan said its already reduced volume of medical prior authorizations by about 15%.

“We want patients to get the care they need when they need it, and we want doctors and their teams to be able to focus on patients – not paperwork,” Amy Flaster, M.D., chief medical officer at the The Cigna Group, said in a statement. “We are leading much-needed improvements to make prior authorization clearer and more consistent. While this is important progress, we know there’s more to do as we continue our journey to deliver a simpler, more personalized health care experience to all those we serve.”

https://www.fiercehealthcare.com/payers/unitedhealthcare-aetna-tout-progress-standardize-prior-authorization-part-industry-wide