Humana pledges to simplify prior authorization process

Health insurer Humana has said it’s engaging in efforts to streamline the prior authorization process, in part by approving care requests as quickly as possible and reducing the administrative burdens for physicians.

The insurer anticipates this will reduce the number of prior authorization requirements and make the process faster and more seamless. Humana pledged to preserve the system of checks and balances that protects patient safety by reviewing and approving the most high-cost, high-risk treatments before care is delivered.

The pledge is part of a recent series of commitments made by various health plans to streamline, simplify and reduce prior authorizations. Elevance and CVS Health are among the other insurers that committed to this industry-wide effort.

These commitments are being implemented across insurance markets, including for those with commercial coverage, Medicare Advantage and Medicaid managed care consistent with state and federal regulations, and stand to benefit about 257 million Americans, according to AHIP.

Insurers are promising faster and more direct access to appropriate treatments for patients, and for providers, more efficient and transparent prior authorization workflows.

WHAT’S THE IMPACT

Humana is taking a number of steps. By Jan. 1, 2026, Humana will eliminate about one third of prior authorizations for outpatient services and will remove the authorization requirement for diagnostic services across colonoscopies and transthoracic echocardiograms and select CT scans and MRIs.

The insurer also promised a faster, more streamlined process for approvals. Humana will provide a decision within one business day on at least 95% of all complete electronic prior authorization requests by Jan. 1, the organization said.

It’s also creating a new, national gold card program for physicians that waives prior authorization requirements for certain items and services for providers with a good track record of submitting appropriate coverage requests.

Also in 2026, Humana will report publicly its prior authorization metrics – including prior authorization requests approved, denied and approved after appeal, and average time between submission and decision. The company said it’s working to expedite implementation of the new federal transparency requirements.

Humana added that it’s working to advance interoperability, which it expects will speed up the prior authorization process and reduce administrative burdens for providers. The company said it’s already working to enhance electronic health record integration via technology, and is supporting greater adoption of prior authorization requests submitted electronically compared to other methods like fax or phone.

THE LARGER TREND

During a press conference in June, Dr. Mehmet Oz, administrator for the Centers for Medicare and Medicaid Services, touted the insurance industry’s efforts at prior authorization reform, particularly singling out “inefficient administrative processes” that, if addressed, could save "tens of billions of dollars in administrative waste."

Participating health plans have signaled that they're implementing common, transparent submissions for electronic prior authorization. This commitment includes the development of standardized data and submission requirements (using FHIR APIs) that will support streamlined processes and faster turnaround times. The goal is to have a new framework up and running by Jan. 1, 2027.

Individual plans will also commit to specific medical prior authorization reductions, as appropriate for each plan's local market, with demonstrable results by Jan. 1, 2026.