Humana to Slash Prior Authorization Requirements for Outpatient Services.

Humana plans to reduce prior authorizations for outpatient services by one-third next year, aiming to accelerate care delivery. This decision comes amidst a lawsuit refiled by Humana against Medicare Star Ratings. The insurance company will also implement other measures to streamline the care process.

Title: Humana's Plan to Streamline Care Delivery by Reducing Prior Authorizations

Humana Inc., a leading health and well-being company, has announced plans to reduce prior authorizations for outpatient services by approximately one-third by January 1, 2026. This move aims to accelerate care delivery and reduce administrative burdens for physicians. The announcement comes amidst a lawsuit refiled by Humana against Medicare Star Ratings, which could impact the company's financial standing.

The health insurer plans to eliminate authorization requirements for diagnostic services such as colonoscopies, transthoracic echocardiograms, and select CT scans and MRIs. Additionally, Humana will ensure that 95% of all complete electronic prior authorization requests receive a decision within one business day by the same date. The company also plans to launch a national gold card program in 2026, which will waive prior authorization requirements for providers with a proven record of submitting coverage requests that meet medical criteria.

Furthermore, Humana will publicly report its prior authorization metrics in 2026, including requests approved, denied, and approved after appeal, as well as the average time between submission and decision. This increased transparency is part of Humana's ongoing efforts to streamline the care approval process.

The company's commitment to reducing prior authorizations builds upon recent industry-wide initiatives announced by AHIP and the Blue Cross Blue Shield Association. Jim Rechtin, President and CEO of Humana, stated, "Today’s healthcare system is too complex, frustrating, and difficult to navigate, and we must do better. 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."

Humana's efforts to expedite the prior authorization process are part of its broader strategy to advance interoperability and reduce administrative burdens on providers. The company is working to enhance electronic health record integration and support greater adoption of electronic prior authorization requests.

In addition to these internal commitments, Humana has long supported the Improving Seniors’ Timely Access to Care Act, bipartisan legislation recently reintroduced in Congress that would further modernize the prior authorization process and expedite the adoption of electronic prior authorization (ePA).

References:
1. [Investing.com](https://www.investing.com/news/company-news/humana-to-reduce-prior-authorizations-streamline-care-approval-process-93CH-4145339)
2. [Reuters](https://www.reuters.com/legal/litigation/humana-renews-challenge-downgrade-us-medicare-star-ratings-2025-07-21/)
3. [STAT News](https://www.statnews.com/2025/07/22/humana-cms-medicare-advantage-ratings-lawsuit-refiles/)
4. [Business Wire](https://www.businesswire.com/news/home/20250722551810/en/Humana-Accelerates-Efforts-to-Eliminate-Prior-Authorization-Requirements-to-Ensure-a-Faster-More-Seamless-Process)