American insurers to optimize prior authorizations

Major American insurers announced Monday that they have agreed to speed up and smooth out the processes involved with the reception and administration of health care by streamlining the prior authorization process.

The AHIP health insurance industry trade association explained in a press release that dozens of large insurers such as Blue Cross Blue Shield, Humana, Cigna and UnitedHealthCare have voluntarily agreed to "streamline, simplify and reduce prior authorization," a move intended to better connect patients to necessary care while cutting down on the clerical loads of providers.

"The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike," said AHIP President and CEO Mike Tuffin.

According to the companies, 257 million Americans should benefit from the changes, which will be implemented across markets, and include commercial coverage and some Medicare and Medicaid plans.

"Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system," he added.

Prior authorization requires that providers attain approval from a patient's insurance company before they can conduct services or treatments. The press release said that such authorizations can lead to the denial or delays of medically necessary care, while also causing "physician burnout."

The plan is to create a "common standard" in regard to the submission of electronic prior authorization requests by the beginning of 2027, at which point at least 80% of authorization request approvals will be receive real time responses.

Individual plans will also reduce claim types that are subject to prior authorization requests by 2026.

"We are encouraged by this collective commitment to reform prior authorization practices," said Executive Vice President and CEO of the American Academy of Family Physicians Shawn Martin. "Physicians have long advocated for reforms that help ensure that patients receive timely, medically necessary care and reduce administrative burden, including the elimination of unnecessary prior authorizations."

However, prior authorizations aren't going away, and insurers involved with the change are scheduled to meet with U.S. Heath and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services Administrator Mehmet Oz Monday.