Prior‑auth standardisation gains momentum

More than 50 U.S. health plans said this week they are standardizing how doctors submit prior-authorization requests, a process that often delays approvals for tests, drugs and procedures. (prnewswire.com) The group includes The Cigna Group, Aetna, Elevance Health and multiple Blue Cross Blue Shield plans. They said they are using common data elements and submission rules so providers do not have to navigate different forms for each insurer. (prnewswire.com) Prior authorization is the insurer check that requires a doctor to get approval before care is covered. The current system often works like filling out a different tax form for each payer, even when the medical request is similar. (hfma.org) (prnewswire.com) Cigna said one standard is expected to cover about 70% of its prior-authorization volume by the end of 2026. The company also said it has reduced medical prior authorizations by about 15% so far. (prnewswire.com) The insurer effort is aimed at the mechanics of submission: what information is required, how it is sent and how it is received. That can cut phone calls, faxes and duplicate paperwork without changing the underlying medical review. (prnewswire.com) (hfma.org) Federal regulators are pushing on the same bottleneck from another direction. The Centers for Medicare & Medicaid Services has proposed electronic prior-authorization standards for prescription drugs in Medicare Part D, extending a broader shift toward digital processing. (hfma.org) The federal proposal would require covered Part D plans to support electronic prior authorization using national standards and tighter response timelines. Hospitals and physician groups have argued those changes could reduce treatment delays tied to manual workflows. (hfma.org) Doctors and patient advocates have long argued that faster forms do not automatically mean more approvals. A cleaner intake process can remove administrative friction while leaving denials, step therapy and utilization review rules in place. (hfma.org) (prnewswire.com) What happens next is less about whether prior authorization survives than about whether it becomes less manual. The current push puts insurers and regulators on the same track: standardize the paperwork first, then fight over the coverage rules after that. (hfma.org) (prnewswire.com)