Across the healthcare landscape, prior authorization is undergoing significant changes aimed at reducing administrative burden and expediting care delivery.
Here are three major updates to know:
1. Nearly 50 health insurers, representing commercial, Medicare Advantage and managed Medicaid plans covering 257 million Americans, have committed to simplifying and standardizing the process. Participating payers have pledged to implement a standardized electronic prior authorization system by January 1, 2027. Their goal is to enable real-time approval for at least 80% of electronic prior authorization requests by that year.
2. CMS introduced a new model targeting certain traditional Medicare services. The model adds prior authorization requirements for selected services and partners with AI and machine learning companies to optimize the process. The model incentivizes companies based on cost savings generated by reducing payments for unnecessary or non-covered services. Initial rollout is limited to providers in Arizona, Washington, New Jersey, Texas and Oklahoma.3. On the federal level, lawmakers reintroduced the Improving Seniors’ Timely Access to Care Act in May 2025. The bipartisan bill proposes a fully electronic prior authorization process for Medicare Advantage plans, a standardization of clinical data exchange, increased transparency around authorization decisions and clear authority for HHS to establish response timeframes. If passed, the legislation would codify much of the work CMS and industry stakeholders are already piloting.
3. On the federal level, lawmakers reintroduced the Improving Seniors’ Timely Access to Care Act in May 2025. The bipartisan bill proposes a fully electronic prior authorization process for Medicare Advantage plans, a standardization of clinical data exchange, increased transparency around authorization decisions and clear authority for HHS to establish response timeframes. If passed, the legislation would codify much of the work CMS and industry stakeholders are already piloting.
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