Humana Accelerates Efforts to Eliminate Prior Authorization Requirements to Ensure a Faster, More Seamless Process

New effort will expedite approvals, promote access to care, reduce administrative burdens, and enhance the patient experience

LOUISVILLE, Ky.--(BUSINESS WIRE)-- Humana Inc., a leading health and well-being company, today announced accelerated efforts to approve care requests as quickly as possible and reduce the administrative burden for physicians associated with prior authorization. These actions will reduce the number of prior authorization requirements and make the process faster and more seamless, while preserving the system of checks and balances that protects patient safety by ensuring the most high-cost, high-risk treatments are reviewed and approved before care is delivered.

Today’s announcement builds upon the recent series of commitments to streamline, simplify, and reduce prior authorizations made by health plans, including Humana, that were announced by AHIP and the Blue Cross Blue Shield Association.

“Today’s healthcare system is too complex, frustrating, and difficult to navigate, and we must do better,” said Jim Rechtin, President and CEO of Humana. “We are committed to reducing prior authorization requirements and making this process faster and more seamless to better support patients, caregivers, physicians, and healthcare organizations.”

Humana is working to reduce the red tape on prior authorization in several important ways:

• Reducing prior authorization requirements – By January 1, 2026, Humana will eliminate approximately one third of prior authorizations for outpatient services. Humana will remove the authorization requirement for diagnostic services across colonoscopies and transthoracic echocardiograms and select CT scans and MRIs. This will build on Humana’s ongoing efforts to continuously review our prior authorization list to balance ensuring high quality, safe and affordable care for our members, with reducing unnecessary burden for our providers.
• Faster, more streamlined process for approvals – By January 1, 2026, Humana will provide a decision within one business day on at least 95% of all complete electronic prior authorization requests, expediting care decisions and helping beneficiaries get the right care in a timely manner. Currently, Humana provides a decision within one business day on more than 85% of outpatient procedures.
• Creating a national gold card program for physicians – In 2026, Humana will launch a new gold card program that waives prior authorization requirements for certain items and services for providers who have a proven record of submitting coverage requests that meet medical criteria and delivering high-quality health care with consistent outcomes for Humana members.

In addition, the company is committing to greater transparency on prior authorization. In 2026, Humana will report publicly its prior authorization metrics – including prior authorization requests approved, denied, and approved after appeal, and average time between submission and decision. Humana is working to expedite implementation of the new federal transparency requirements.

Humana is Working to Advance Interoperability to Reduce Administrative Burdens

Humana is working to advance interoperability to ensure that doctors, hospitals, and health plans have timely, secure access to the right information so patients get better, more coordinated care. These efforts to speed up the prior authorization process support Humana’s goal of advancing interoperability and reducing administrative burdens on providers. For example, Humana is already working to:

• Enhance electronic health record integration by leveraging technology to keep more providers in their existing workflows for authorization submission and referrals, further reducing the administrative burden and reducing transaction turnaround times.
• Support greater adoption of prior authorization requests submitted electronically compared to other methods like fax or phone and modernize and streamline electronic prior authorization (ePA) to expedite approval of ePA requests and deliver a better, more seamless end-to-end experience for patients, providers, and payers.

Humana Supports Action on Bipartisan Prior Authorization Legislation

In addition to these internal commitments, Humana also has long supported the Improving Seniors’ Timely Access to Care Act, bipartisan legislation recently reintroduced in Congress that would further modernize the prior authorization process and expedite adoption of electronic prior authorization (ePA). Humana supported this legislation in the last two Congresses and supports efforts in the House and Senate to advance this bill again.

About Humana
Humana Inc. (NYSE:HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell health care services, we strive to make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Media:

Kevin Smith

Humana Corporate Communications

Ksmith305@humana.com

Source: Humana Inc.