Big health insurers said today that they will standardize the process for submitting requests for prior authorizations for coverage for many common procedures by Jan. 1, 2027.
Managers of the standards effort will start by applying it to “medical services that are commonly subject to prior authorization, such as orthopedic surgeries and imaging services, including CT scans and MRIs,” according to America’s Health Insurance Plans.
The effort will include commercial health plans as well as Medicare Advantage plans and Medicaid managed care plans, AHIP said.
“Additional services will be added over time,” AHIP said.
The list of carriers participating in the effort includes Centene, Cigna, GuideWell, Humana, Kaiser Permanente, Molina Healthcare, UnitedHealthcare, and the Blue Cross and Blue Shield carriers that still operate as independent entities.
The list also includes Elevance, Health Care Service Corp., Regence and Highmark. Those are organizations that control Blue Cross and Blue Shield carriers in multiple states.
Cigna, a company that recently said it has already cut its prior authorization volume by 15%, predicted that it will use the new standards for 70% of prior authorization volume.
UnitedHealth said it now uses the standards for more than half of its review volume and hopes to increase the percentage to 70%.
What it means: If prior authorization reviews really speed up, employer plan participants and their health care providers might be happy.
Employers and benefits advisors might need time to see how the shift would affect claim costs and health plan participants’ access to care.
The backdrop: The new announcement comes as health care providers are trying to reduce the impact of prior authorization efforts on their lives.
Plans and plan administrators argue that making patients ask in advance whether certain treatments will be covered helps plans discourage use of unnecessary, overly expensive or potentially dangerous care.
Providers say plans require reviews for too many procedures, often handle the reviews slowly, often use reviewers without the necessary knowledge to review the requests, and tend to use a hodgepodge of different claim formats and submission systems.
Dr. Mehmet Oz, a cardiothoracic surgeon who is now the administrator of the Centers for Medicare & Medicaid Services, has made narrowing the scope of prior authorization efforts one of his top policy priorities, and insurers promised in June 2025 to improve review processes.
Earlier this month, insurers reported on their progress by providing narrative descriptions of their efforts to improve their prior authorization efforts.
Some insurers estimated how much they had reduced prior authorization review volume, but some did not, and each insurer used its own reporting format.
Players on each side are accusing the players of using artificial intelligence technology in ways that make review processes worse.
Some commenters have argued that the conflict between plans and providers over prior authorizations could be solved if both sides agreed to use AI systems designed to work collaboratively to resolve care recommendation conflicts rather to intensify conflicts.
The WISeR model test program: One reason for a surge in discussions about prior authorization reviews this week is early provider reaction to a new Medicare prior authorization review program.
Original Medicare exposes patients to the risk of having to pay many deductibles, coinsurance payments and co-payments.
Original Medicare has made minimal use of prior authorization reviews. It has counted on the deductibles and coinsurance bills to discourage unnecessary use of care.
The Medicare Advantage lets private insurers sell plans that fill in many of the Original Medicare coverage gaps. Typical plans in the program use prior authorization reviews to try to improve the quality of care and hold down the cost.
Recently, Original Medicare managers decided to test use of prior authorization reviews on Original Medicare by developing the Wasteful and Inappropriate Service Reduction model test program, or WISeR program.
The WISeR test program took effect in six states Jan. 1.
WISeR designers hope to show that use of more prior authorization reviews will make the Original Medicare program more efficient.
But Sen. Maria Cantwell, D-Wash., posted a report this week showing that hospitals in her state hate the program.
Washington state hospitals say completing the procedures included in the WISer test program now takes two to four times longer than in 2025 because of WISeR-related delays.
The University of Washington Medical System, for example, says getting standard approvals for one common procedure, epidural steroid pain injections, now takes more than 15 days, up from three days before the WISer program started.
The Medicare Advantage prior authorization bill: House members introduced a bipartisan bill Monday that would reduce the amount of time Medicare Advantage plans have to process the prior authorization requests they get.
The bill would also require Medicare Advantage plans to use automated prior authorization processing systems.
The bill was introduced by Rep. John Joyce, R-Pa. At press time, it had three Democratic co-sponsors and three Republican co-sponsors, according to the official Congress.gov bill record.