Days after a federal judge dismissed Humana’s lawsuit against the Centers for Medicare & Medicaid Services (CMS) over its 2025 Medicare Advantage Star ratings, the insurer has filed a new complaint that asks the court to set aside the rating and have CMS recalculate its score. Meanwhile, Humana announced big changes to its prior authorization processes.
Humana on Monday filed a second lawsuit over its 2025 Star ratings, asking the U.S. District Court for the Northern District of Texas to expedite the matter and have CMS retract and recalculate its Star rating before the annual enrollment period for 2026 begins on October 15.
Last week the country’s second-largest Medicare Advantage insurer lost its original case against CMS after Judge Reed O’Connor dismissed it on technical grounds, stating that at the time that Humana filed the lawsuit, it had not exhausted all options outside of court to challenge the ratings. However, O’Connor dismissed the case without prejudice, which allowed the insurer to refile the lawsuit.
The original lawsuit claimed CMS miscalculated the cut points of more than one dozen Humana Medicare Advantage contracts. The insurer said that CMS would not allow it to validate, and therefore it could not fully challenge the calculations because the agency denied the company access to the data necessary for doing so. The refusal to disclose the information was “arbitrary, capricious, and unlawful,” the lawsuit said.
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The new lawsuit focuses on the downgraded Stars rating for its largest plans based on three CMS test calls at Humana’s customer service centers that the agency conducted to determine whether representatives could answer questions in languages other than English. Two of the calls were dropped due to technical problems before the customer service representative could connect the secret shopper to an interpreter. The third call was connected, but Humana said the test caller remained silent during the entire duration. After several minutes of silence with no communication, the call was disconnected.
Humana said that it is already suffering reputational harm from the inaccurate 2025 Star ratings and asked the court to quickly weigh in on the case so that CMS can retract and recalculate the quality ratings before the annual enrollment period for 2026.
Revamped prior authorization process
Humana is also making news this week for announcing it will eliminate one-third of prior authorizations for outpatient services. The announcement comes in the wake of recent commitments the insurer made with other health plans to streamline, simplify, and reduce prior authorizations.
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Humana said it is taking steps to:
Reduce prior authorization requirements: By January 1, 2026, Humana said it will eliminate approximately one-third of prior authorizations for outpatient services by removing the authorization requirement for diagnostic services across colonoscopies and transthoracic echocardiograms and select CT scans and MRIs.
Accelerate the approval process: By January 1, 2026, Humana will provide a decision within one business day on at least 95 percent of all complete electronic prior authorization requests. Currently, Humana provides a decision within one business day on more than 85 percent of outpatient procedures.
Create 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.
Humana said it also will begin reporting on its prior authorization metrics in 2026. Those metrics include the number of prior authorization requests approved, denied, and approved after appeal, and the average time between submission and decision.