A group of insurance companies nationwide agreed to simplify and reduce prior authorization requirements with new actions.
AHIP (Advancing Health Insurance Providers) announced a series of commitments that it says will protect those insured by quickly connecting them to the care they need.
The commitments are also being implemented for those with Medicare Advantage and Medicaid. AHIP said the change will benefit 257 million Americans.
“The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike,” said AHIP CEO Mike Tuffin. “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.”
Participating health plans are committing to standardizing electronic prior authorization by 2027 and implementing a common submission process to make it faster and more transparent for patients. By 2026, they vow to ensure continuity of care when patients change plans or insurance companies during treatment, enhance communication and transparency on determinations and reduce the scope of claims subject to prior authorization.
Any non-approved requests will be subject to a medical review.
"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.”
Health insurance claim denials have increased, even when patients receive care in-network. Health policy and research group KFF found that one insurer denied 80% of claims in 2020 and another denied 49% in 2021.
The signatories include:
- 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
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