WASHINGTON, D.C. – Health insurance plans today announced a series of commitments to streamline, simplify and reduce prior authorization – a critical safeguard to ensure their members’ care is safe, effective, evidence-based and affordable. Building on health plans’ existing efforts, these new actions are focused on connecting patients more quickly to the care they need while minimizing administrative burdens on providers.
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 will benefit 257 million Americans.
For patients, these commitments will result in faster, more direct access to appropriate treatments and medical services with fewer challenges navigating the health system.
For providers, these commitments will streamline prior authorization workflows, allowing for a more efficient and transparent process overall, while ensuring evidence-based care for their patients.
“The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike. 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,” said AHIP President and CEO Mike Tuffin.
“These measurable commitments – addressing improvements like timeliness, scope and streamlining – mark a meaningful step forward in our work together to create a better system of health,” said Kim Keck, President and CEO, Blue Cross Blue Shield Association. “This is an important foundation to address bigger problems together, at a time when technology and interoperability can deliver real improvements to patient experience.”
Participating health plans commit to:
- Standardizing Electronic Prior Authorization. Participating health plans will work toward 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 seamless, streamlined processes and faster turn-around times. The goal is for the new framework to be operational and available to plans and providers by January 1, 2027.
- Reducing the Scope of Claims Subject to Prior Authorization. Individual plans will commit to specific reductions to medical prior authorization as appropriate for the local market each plan serves, with demonstrated reductions by January 1, 2026.
- Ensuring Continuity of Care When Patients Change Plans. Beginning January 1, 2026, when a patient changes insurance companies during a course of treatment, the new plan will honor existing prior authorizations for benefit-equivalent in-network services as part of a 90-day transition period. This action is designed to help patients avoid delays and maintain continuity of care during insurance transitions.
- Enhancing Communication and Transparency on Determinations. Health plans will provide clear, easy-to-understand explanations of prior authorization determinations, including support for appeals and guidance on next steps. These changes will be operational for fully insured and commercial coverage by January 1, 2026, with a focus on supporting regulatory changes for expansion to additional coverage types.
- Expanding Real-Time Responses. In 2027, at least 80 percent of electronic prior authorization approvals (with all needed clinical documentation) will be answered in real-time. This commitment includes adoption of FHIR® APIs across all markets to further accelerate real-time responses.
- Ensuring Medical Review of Non-Approved Requests. Participating health plans affirm that all non-approved requests based on clinical reasons will continue to be reviewed by medical professionals – a standard already in place. This commitment is in effect now.
“Private-sector collaboration and solution-oriented commitments are critical to improve policy and tackle challenges. With membership spanning the entire healthcare continuum, we appreciate the need to balance appropriate medical management with timely access to care. This announcement from health insurance plans is an important step toward improving the prior authorization process,” said Maria Ghazal, President and CEO of the Healthcare Leadership Council. “We must seize this opportunity to turn these initiatives into real, sustained progress for patients.”
"The National Health Council (NHC) welcomes the commitment of health plans to reform prior authorization practices as an encouraging step toward better access to care. For years, the NHC has called for changes that make the system work easier and better for people living with chronic diseases and disabilities,” said Randall Rutta, NHC’s Chief Executive Officer. “The NHC is a ready partner to AHIP, BCBSA and health plans making these commitments to promote meaningful action that reduces administrative burden, increases transparency and centers on the needs of patients.”
“We are encouraged by this collective commitment to reform prior authorization practices. 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,” said Shawn Martin, Executive Vice President and Chief Executive Officer of the American Academy of Family Physicians. “While this commitment is a step in the right direction, we will ultimately measure its impact by real changes in the day-to-day experiences of patients and the physicians who care for them. We look forward to collaborating with payers to ensure these efforts lead to meaningful and lasting improvements in patient care.”
Progress will be tracked and reported. A full list of participating health plans and additional information are available at: www.ahip.org/supportingpatients and https://www.bcbs.com/ImprovingPA.
Industry Leadership Initiative on Prior Authorization
The undersigned health plans voluntarily commit to six actions to improve prior authorization for patients and providers.
AmeriHealth Caritas
Arkansas Blue Cross and Blue Shield
Blue Cross of Idaho
Blue Cross Blue Shield of Alabama
Blue Cross Blue Shield of Arizona
Blue Cross and Blue Shield of Hawaii
Blue Cross and Blue Shield of Kansas
Blue Cross and Blue Shield of Kansas City
Blue Cross and Blue Shield of Louisiana
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of Michigan
Blue Cross and Blue Shield of Minnesota
Blue Cross and Blue Shield of Nebraska
Blue Cross and Blue Shield of North Carolina
Blue Cross Blue Shield of North Dakota
Blue Cross & Blue Shield of Rhode Island
Blue Cross Blue Shield of South Carolina
BlueCross BlueShield of Tennessee
Blue Cross Blue Shield of Wyoming
Blue Shield of California
Capital Blue Cross
Capital District Physicians' Health Plan, Inc. (CDPHP)
CareFirst BlueCross BlueShield
Centene
The Cigna Group
CVS Health Aetna
Elevance Health
Excellus Blue Cross Blue Shield
Geisinger Health Plan
GuideWell Mutual Holding Corporation
Health Care Service Corporation
Healthfirst (New York)
Highmark Inc.
Horizon Blue Cross Blue Shield of New Jersey
Humana
Independence Blue Cross
Independent Health
Kaiser Permanente
L.A. Care Health Plan
Molina Healthcare
Neighborhood Health Plan of Rhode Island
Point32Health
Premera Blue Cross
Regence BlueShield, Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah, Asuris Northwest Health, BridgeSpan Health
SCAN Health Plan
SummaCare
UnitedHealthcare
Wellmark Blue Cross and Blue Shield
About AHIP
AHIP is the national trade association representing the health insurance industry. AHIP’s members provide health care coverage, services and solutions to more than 200 million Americans. We are committed to market-based solutions and public-private partnerships that make high-quality coverage and care more affordable, accessible and equitable for everyone. Learn more at ahip.org.
About the Blue Cross Blue Shield Association
The Blue Cross and Blue Shield Association is a national federation of 33 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. For more information on BCBSA and its member companies, please visit bcbs.com.