More than 60 major health insurance payers pledged to improve prior authorization processes following a June 23 meeting with Health and Human Services Secretary Robert F. Kennedy Jr., and Centers for Medicare & Medicaid Services (CMS) Administrator Mehmet Oz, MD.
Participating health insurers pledged to:
- Standardize electronic prior authorization submissions using Fast Healthcare Interoperability Resources–based application programming interfaces
- Reduce the volume of medical services subject to prior authorization by Jan. 1, 2026
- Honor existing prior authorizations during insurance transitions to ensure care continuity
- Enhance transparency and communication around prior authorization decisions and appeals
- Expand real-time responses, with a goal of real-time approvals for most requests by 2027
- Ensure medical professionals review all clinical denials
Oz noted that CMS will evaluate progress and promote accountability as part of its ongoing efforts to reduce administrative burden and improve timely access to care.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
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