What You Ought to Know:
– Humana Inc. introduced accelerated efforts to approve care requests as rapidly as doable and scale back the executive burden for physicians related to prior authorization.
– These actions purpose to streamline and scale back prior authorization necessities whereas preserving the system of checks and balances that protects affected person security for high-cost, high-risk remedies.
Prior Authorization Reform
Humana is working to cut back the “crimson tape” on prior authorization via a number of vital initiatives:
- Decreasing Prior Authorization Necessities: By January 1, 2026, Humana plans to get rid of roughly one-third of prior authorizations for outpatient companies. This contains eradicating authorization necessities for diagnostic companies comparable to colonoscopies, transthoracic echocardiograms, and choose CT scans and MRIs. This builds on ongoing efforts to evaluate and stability high-quality, secure, and inexpensive care with lowering pointless supplier burden.
- Quicker, Extra Streamlined Approvals: Additionally by January 1, 2026, Humana commits to offering a choice inside one enterprise day on a minimum of 95% of all full digital prior authorization requests. This can expedite care selections, constructing on its present fee of deciding greater than 85% of outpatient procedures inside one enterprise day.
- Nationwide Gold Card Program: In 2026, Humana will launch a brand new gold card program that waives prior authorization necessities for sure objects and companies for suppliers who’ve a confirmed report of assembly medical standards and delivering high-quality care with constant outcomes for Humana members.
- Larger Transparency: In 2026, Humana will publicly report its prior authorization metrics, together with requests accredited, denied, accredited after enchantment, and common time between submission and resolution. This dedication helps the expedited implementation of recent federal transparency necessities.
“At present’s healthcare system is just too advanced, irritating, and troublesome to navigate, and we should do higher,” mentioned Jim Rechtin, President and CEO of Humana. “We’re dedicated to lowering prior authorization necessities and making this course of quicker and extra seamless to raised help sufferers, caregivers, physicians, and healthcare organizations.”
