Roughly 50 insurers signed an AHIP and Blue Cross Blue Shield Association commitment to standardize electronic prior authorization across most medical services, according to an April 24 news release.
The approach will apply to services commonly requiring prior authorization, including imaging and orthopedic surgeries. More services will be added going forward, and the broader prior authorization commitments will span years, the release said.
The industry will gauge feedback from providers and technology vendors on data requirements, aiming for widespread adoption next year. Plans will adopt these standards on a rolling basis.
“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,” AHIP President and CEO Mike Tuffin said.
Last June, in collaboration with HHS and CMS, industry members voluntarily committed to simplifying and reducing prior authorizations. Since then, AHIP and BCBSA reported leading health plans cut 11% of prior authorization requirements, equating to 6.5 million prior authorizations.
UnitedHealthcare recently announced some prior authorization exemptions for rural providers, while Elevance said its Health OS platform and other AI tools lowered prior authorization denials by nearly 70%. Regarding the new commitment, Aetna said it has already standardized 88% of prior authorization volume, and UnitedHealthcare and Cigna are aiming to standardize at least 70%.
Prior to the initial commitment, CMS finalized a rule for payers to send prior authorization decisions within 72 hours for urgent requests and seven calendar days for standard requests. CMS also required payers to publish aggregated 2025 prior authorization metrics by the end of March 2026, but KFF found much of that data lacked insight on what drives approvals and denials. In April, CMS proposed interoperability APIs and shorter timelines for drugs.
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