On Monday, June 23, the U.S. secretary of Health and Human Services, alongside the Centers for Medicare & Medicaid Services administrator, revealed a voluntary agreement from insurers to streamline the prior authorization process. This announcement came as a response to administrative barriers and lengthy wait times, which have delayed timely health care for many patients in recent years.
The pledge involves standardizing electronic prior authorization submissions, reducing the number of required prior authorizations, honoring prior approvals during plan changes, expanding real-time responses, enhancing transparency and ensuring medical review of denials. Participating insurers cover approximately 75% of the insured population nationwide, and according to Blue Cross Blue Shield’s chief executive, these new commitments represent significant progress in enhancing the speed and breadth of health care services.
The reforms plan to roll out early next year and could reduce bureaucratic hurdles that currently block patient care, though experts note ongoing Medicaid work requirements may add new burdens.
