Health insurance plans are joining forces to streamline, simplify, and reduce prior authorization.

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.

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 turnaround 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% 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.

Experts React

“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,” says Mike Tuffin, the President and CEO of AHIP, the national trade association representing the health insurance industry, in a news release.

“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,” adds 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.”

“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,” says 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,” says 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.”

Progress will be tracked and reported.

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

A full list of participating health plans and additional information are available at: www.ahip.org/supportingpatients and https://www.bcbs.com/ImprovingPA