What You Should Know:
– Humana Inc. announced accelerated efforts to approve care requests as quickly as possible and reduce the administrative burden for physicians associated with prior authorization.
– These actions aim to streamline and reduce prior authorization requirements while preserving the system of checks and balances that protects patient safety for high-cost, high-risk treatments.
Prior Authorization Reform
Humana is working to reduce the “red tape” on prior authorization through several important initiatives:
- Reducing Prior Authorization Requirements: By January 1, 2026, Humana plans to eliminate approximately one-third of prior authorizations for outpatient services. This includes removing authorization requirements for diagnostic services such as colonoscopies, transthoracic echocardiograms, and select CT scans and MRIs. This builds on ongoing efforts to review and balance high-quality, safe, and affordable care with reducing unnecessary provider burden.
- Faster, More Streamlined Approvals: Also by January 1, 2026, Humana commits to providing a decision within one business day on at least 95% of all complete electronic prior authorization requests. This will expedite care decisions, building on its current rate of deciding more than 85% of outpatient procedures within one business day.
- National Gold Card Program: 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 meeting medical criteria and delivering high-quality care with consistent outcomes for Humana members.
- Greater Transparency: In 2026, Humana will publicly report its prior authorization metrics, including requests approved, denied, approved after appeal, and average time between submission and decision. This commitment supports the expedited implementation of new federal transparency requirements.
“Today’s healthcare system is too complex, frustrating, and difficult to navigate, and we must do better,” said Jim Rechtin, President and CEO of Humana. “We are committed to reducing prior authorization requirements and making this process faster and more seamless to better support patients, caregivers, physicians, and healthcare organizations.”
