The initiative builds on insurers’ voluntary commitments to reduce administrative burden and speed access to medically necessary services.
Health plans participating in an industry‑led effort to simplify prior authorization announced Friday that they will begin using a standardized electronic submission process for most medical services by January 1, 2027, a move they say will accelerate patient access to care and reduce administrative burden for providers.
The initiative, led by AHIP, the health insurance industry’s national trade association, applies to electronic prior authorization requests across commercial coverage, Medicare Advantage, and Medicaid managed care. Participating plans will adopt a common approach to submitting and reviewing prior authorization requests for services such as orthopedic surgeries and advanced imaging, including CT scans and MRIs. Health plans may expand the list of covered services over time.
Insurers often require prior authorization, or pre‑approval, before covering certain services or procedures as a way to control costs and ensure patients receive clinically appropriate, evidence‑based care. But patients consistently cite prior authorization as one of the biggest challenges in navigating the health care system, and provider groups have long argued the process can delay treatment and create unnecessary administrative hurdles.
Concerns about prior authorization have drawn increasing scrutiny from federal policymakers. A Senate investigation found that some Medicare Advantage insurers improperly denied requests for post‑acute care, while the Centers for Medicare & Medicaid Services (CMS) has finalized a rule aimed at streamlining prior authorization requirements. Meanwhile, CMS recently launched a pilot program in original Medicare to test whether artificial intelligence can speed prior authorization decisions for services deemed vulnerable to fraud, waste, and abuse. That pilot, which began January 1 in six states, has already generated complaints over delayed or disrupted care.
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Despite ongoing criticism, insurers continue to defend prior authorization as an important safeguard. Health plans say delays often occur when requests are submitted with incomplete or inaccurate documentation, requiring providers to resubmit information before a determination can be made.
AHIP said dozens of health plans have committed to improving the system through voluntary, multi‑year reforms developed in partnership with the Departments of Health and Human Services and CMS. Since those commitments were first announced in June 2025, participating plans report an 11 percent reduction in prior authorization requirements across markets, including more than a 15 percent reduction in Medicare Advantage.
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The new standardized submission process represents the next phase of that effort, AHIP said. Importantly, the standards are intended to simplify how prior authorization requests are submitted and processed, not to change individual health plans’ coverage policies or clinical decision‑making criteria.
“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,” AHIP President and CEO Mike Tuffin said in a statement.
Kim Keck, president and CEO of the Blue Cross Blue Shield Association, said collaboration with providers will remain essential as the standards roll out.
AHIP said participating plans will work with provider organizations and health technology companies over the next two years to align on data requirements and support broad adoption of the standards. While the formal launch date is January 1, 2027, health plans will begin implementing the standardized approach on a rolling basis as systems and workflows are updated.