In recent news, several major health plans have agreed to adopt a standardized method for electronically-submitted prior authorization requests.
The goal?
- Accelerate patient access to care
- Reduce the administrative burden for providers
Medical services covered by the standardized approach include those often subject to prior authorization requirements, including imaging services and orthopedic surgeries. Additional services - spanning commercial coverage, Medicare Advantage, and Medicaid managed care - are planned to be added over time.
Mike Tuffin, AHIP president and CEO, states: “As more providers adopt electronic prior authorization, this standardized approach will mean faster answers for patients, a more consistent experience for providers and less friction for everyone.”
The initial list of voluntarily participating health plans include:
- American Specialty Health
- 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
- CareFirst BlueCross BlueShield
- CareSource
- Centene
- The Cigna Group
- CVS Health Aetna
- Elevance Health
- Evry Health
- Excellus Blue Cross Blue Shield
- Geisinger Health Plan
- GuideWell Mutual Holding Corporation (Florida Blue and Triple-S)
- Health Care Service Corporation
- Highmark Inc.
- Horizon Blue Cross Blue Shield of New Jersey
- Humana
- Independence Blue Cross
- Kaiser Permanente
- L.A. Care Health Plan
- Medical Mutual of Ohio
- Molina Healthcare
- Neighborhood Health Plan of Rhode Island
- Oscar Health
- 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
- Sentara Health Plans
- UnitedHealthcare
- Wellmark Blue Cross and Blue Shield
The aforementioned standardization commitment is implemented beginning Jan. 1, 2027, and health plans participating will adopt these on a rolling basis.
Additional information on standardized prior authorization can be found here: https://www.hmenews.com/article/health-plans-to-standardize-prior-auth-processes.
