Aetna, Cigna, UnitedHealth standardize prior authorization
- Aetna, Cigna, UnitedHealthcare and dozens of other plans said April 24 they will standardize electronic prior-authorization submissions for common medical services by 2027. - The rollout starts with imaging and orthopedic procedures across commercial, Medicare Advantage and Medicaid managed care, with insurers adding more services over time. - The push follows 2025 insurer pledges and an 11% volume drop in prior authorizations. (ahip.org)
Major U.S. health insurers said April 24 they will start using a common electronic prior-authorization submission process for many routine medical services beginning January 1, 2027. (ahip.org) The initiative was announced by AHIP and the Blue Cross Blue Shield Association, with participating plans including Aetna, The Cigna Group, UnitedHealthcare and Elevance-affiliated Blue plans. (ahip.org) (bcbs.com) The first wave covers services that are often flagged for prior authorization, including orthopedic surgeries and imaging such as computed tomography scans and magnetic resonance imaging. (ahip.org) The insurers said the common format is meant to reduce incomplete submissions, which now force doctors’ offices to resend records and can delay decisions. AHIP said the standards will not change any plan’s clinical rules or coverage decisions. (ahip.org) The change builds on a voluntary industry pledge announced with the Department of Health and Human Services and the Centers for Medicare & Medicaid Services in June 2025. AHIP said participating plans have already cut prior-authorization volume by 11%. (ahip.org) (bcbs.com) UnitedHealthcare said more than half of its prior-authorization volume is already included in the industry standardization effort, and it expects that share to top 70% by the end of 2026. (unitedhealthgroup.com) The Cigna Group said the standard approach should cover medical services representing more than 70% of its prior-authorization volume by the end of 2026, after it had already reduced overall medical prior authorizations by about 15%. (newsroom.thecignagroup.com) Federal rules are moving on a parallel track. CMS’ 2024 prior-authorization interoperability rule began phasing in on January 1, 2026, including decision deadlines of seven calendar days for standard requests and 72 hours for urgent ones, with payer prior-authorization application programming interfaces due January 1, 2027. (forvismazars.us) (cms.gov) The insurers’ new promise is narrower than a rewrite of prior authorization itself. It standardizes the paperwork and data fields for electronic requests, while leaving each insurer’s medical-necessity criteria and approval decisions in place. (ahip.org) (unitedhealthgroup.com) Plans said they will adopt the standards on a rolling basis through 2027 as provider groups and technology vendors weigh in on the required data. The pitch is simpler forms first, not the end of prior authorization. (ahip.org)
