Humana to Eliminate Prior Authorizations for Medicare Advantage Programs by 2026
In a significant move towards simplifying the healthcare system, Humana, the second largest provider of Medicare Advantage plans, has announced plans to reduce its use of prior authorizations and speed up the process.
According to a recent analysis by the Kaiser Family Foundation (KFF), in 2023, Humana had an average of 3.1 prior authorization requests per MA enrollee and a denial rate of 3.5%. Recognising the need for change, Humana aims to eliminate about one-third of prior authorization requirements for outpatient services by early 2026.
Common diagnostic tests like colonoscopies, certain CT scans, MRIs, and selected heart monitoring tests will no longer require prior authorization, aiming to reduce administrative burdens and accelerate access to necessary care.
Humana also plans to provide decisions on at least 95% of electronically submitted prior authorization requests within one business day, improving efficiency over current response times.
To further enhance transparency and trust, Humana will publicly report prior authorization metrics such as approval and denial rates, outcomes after appeals, and average decision time starting in 2026.
Moreover, Humana is introducing a national gold card program that waives certain prior authorization requirements for physicians with a proven track record of high-quality care and timely submissions. This initiative aims to simplify the process for trusted providers.
Jim Rechtin, President and CEO of Humana, stated that the current healthcare system is too complex, frustrating, and difficult to navigate. Rechtin emphasised that Humana is committed to reducing prior authorization requirements and making the process faster and more seamless.
Humana's commitment to streamline prior authorization processes was made at a Health and Human Services (HHS) roundtable attended by Secretary Kennedy and CMS Administrator Dr. Oz. Humana has also joined other signatories in a pledge to streamline prior authorization processes for Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace®, and commercial plans.
These initiatives could lead to less waiting for patients and less paperwork for doctor's offices, ultimately making the healthcare system more accessible and user-friendly. By reducing administrative burdens, accelerating access to necessary care, and increasing transparency, Humana aims to maintain patient safety while improving the overall healthcare experience.
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- To foster a more efficient health-and-wellness ecosystem and improve the overall Medicare experience, Humana aims to reduce prior authorization requirements, especially in outpatient services such as common diagnostic tests like colonoscopies, certain CT scans, MRIs, and selected heart monitoring tests.
- In a bid to increase transparency and implement science-based regulations, Humana will publicly report prior authorization metrics and join other industry stakeholders in pledging to streamline prior authorization processes across Medicare Advantage, Medicaid Managed Care, Health Insurance Marketplace, and commercial plans.
