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Health insurers are set to unveil major changes to overhaul their prior authorization requests as early as next week in a bid to smoothen the process that can determine whether a patient is eligible to receive healthcare coverage, The Wall Street Journal reported Friday.
Leading health insurers will pledge to create a common standard by the start of 2027 for submitting electronic requests for prior authorizations, also known as preauthorizations, people familiar with the matter said.
The initiative to be announced early next week also includes plans to answer 80% of electronic requests in real-time by 2027 only if submissions are forwarded with all the relevant documentation.
Other changes include plans to review all prior authorization denials by medical professionals and narrow the scope of procedures subject to prior authorizations without setting any numerical targets for companies.
The move comes amid complaints from the industry about the bureaucratic burden of prior authorizations, which require hospitals and doctors to obtain coverage approvals from health plans before initiating certain non-emergency medical procedures in patients.
A spokesperson for industry lobby group America’s Health Insurance Plans (AHIP) didn’t immediately respond to requests for comments.
Selected health insurers: UnitedHealth (NYSE:UNH), Humana (HUM), CVS Health (NYSE:CVS), Cigna (NYSE:CI), Clover Health (CLOV), Alignment Healthcare (ALHC), Centene (CNC), Molina Healthcare (MOH), and Elevance Health (NYSE:ELV).