Humana Announces Efforts to Streamline Care Approvals and Reduce Prior Authorization Delays

Humana has announced plans to reduce prior authorization delays and streamline care approvals by eliminating one-third of prior authorizations for outpatient services, providing a decision within one business day on at least 95% of complete electronic prior authorization requests, and launching a new gold card program that waives prior authorization requirements for certain items and services for providers who have a proven record of submitting coverage requests that meet medical criteria. The company will report publicly its prior authorization metrics in 2026.

Humana Inc. (HUM.N) has announced a series of initiatives aimed at reducing prior authorization delays and streamlining care approvals for outpatient services. The company aims to eliminate approximately one-third of prior authorization requirements by January 1, 2026, and will provide decisions on at least 95% of complete electronic prior authorization requests within one business day by the same date [1].

Humana's CEO, Jim Rechtin, emphasized the need to simplify the healthcare system, stating, "Today’s healthcare system is too complex, frustrating, and difficult to navigate, and we must do better" [2]. The company will remove authorization requirements for diagnostic services such as colonoscopies, transthoracic echocardiograms, and select CT scans and MRIs [1].

In addition to these changes, Humana plans to launch a "gold card" program in 2026 that waives prior authorization requirements for providers with a proven record of submitting coverage requests that meet medical criteria and deliver high-quality care [2]. The company will also increase transparency by publicly reporting prior authorization metrics in 2026, including requests approved, denied, approved after appeal, and average decision times [2].

These initiatives build upon commitments previously announced by health plans, including Humana, through AHIP and the Blue Cross Blue Shield Association. Humana supports the bipartisan Improving Seniors’ Timely Access to Care Act, which aims to modernize the prior authorization process [2].

Humana's actions come as part of a broader industry effort to address prior authorization burdens and improve the healthcare experience for patients and providers. The company has maintained strong financial metrics, with a healthy P/E ratio of 15.8 and a consistent dividend payment history spanning 15 years [2].

References:
[1] Reuters. (2025, July 22). Humana to reduce about one-third prior authorization requirements by 2026. Retrieved from https://www.reuters.com/business/healthcare-pharmaceuticals/humana-reduce-about-one-third-prior-authorization-requirements-2025-07-22/
[2] InvestingPro. (2025, July 22). Humana to cut prior authorization requirements by one-third. Retrieved from https://za.investing.com/news/company-news/humana-to-cut-prior-authorization-requirements-by-onethird-93CH-3798137