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Humana announced on July 22 that it would accelerate efforts to eliminate its prior authorization requirements.
“We are committed to reducing prior authorization requirements and making this process faster and more seamless to better support patients, caregivers, physicians, and health care organizations,” Jim Rechtin, president and CEO of Humana, said in a press release.
By Jan. 1, 2026, Humana will:
- eliminate approximately one-third of prior authorizations for outpatient services, including diagnostic services across colonoscopies and transthoracic echocardiograms and select computed tomography scans and magnetic resonance imaging;
- provide a decision within one business day on at least 95 percent of all complete electronic prior authorization requests;
- make all prior authorization metrics publicly available, including approvals, denials, and approvals after appeal, to expedite implementation of new federal transparency requirements;
- advance interoperability and reduce administrative burden through electronic health record integration; and
- encourage submission of electronic prior authorization requests over fax or phone requests.
In 2026, Humana will also launch a gold card program that waives prior authorization requirements for certain items and services for providers who consistently submit coverage requests in accordance with medical criteria and deliver high-quality health care for Humana members.
In the press release announcing these efforts, Humana also reiterated its support of the Improving Seniors’ Timely Access to Care Act (H.R. 3514), reintroduced to Congress on May 21, which would establish an electronic prior authorization process for Medicare Advantage plans, including a standardization for transactions and clinical attachments.
Sources:
Stay Compliant with CMS and the New ABN Requirements
The Centers for Medicare & Medicaid Services (CMS) has issued an updated version of the Advance Beneficiary Notice of Noncoverage (ABN).
Prior Authorization Process Reform in Medicare Advantage Gaining Traction in Congress
The Improving Seniors’ Timely Access to Care Act (S.1816/H.R.3514) is gaining significant bipartisan support in both chambers of Congress.