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What plans promised and report
In June 2025, AHIP and the Blue Cross Blue Shield Association announced voluntary commitments, made with HHS and CMS, to simplify prior authorization for plans covering 257 million people. On April 7, the groups reported that participating plans eliminated 11% of prior authorizations across a range of medical services, or about 6.5 million fewer requests, with a reduction of more than 15% in Medicare Advantage. Plans now honor existing authorizations for in-network, benefit-equivalent services for 90 days when a patient changes plans.
Two larger commitments remain. Plans pledged a standardized electronic prior authorization framework by January 1, 2027, and to answer at least 80% of complete electronic requests in real time in 2027.
Why hospitals should verify
An 11% reduction is meaningful, but hospitals experience prior authorization through specific services, payers and denial patterns, not national averages. Cuts may land on low-volume codes while high-volume imaging, procedures and post-acute placements still require approval. Real-time responses also depend on providers being able to submit electronically through their own systems, which requires investment and testing on the hospital side. Without that work, the promised speed may not reach your schedulers and clinicians.
What to do this year
- Measure by payer: Track authorization volume, turnaround and denial rates for your top commercial and Medicare Advantage payers, compared with 2025.
- Raise gaps in contract talks: Use your data in joint operating meetings and negotiations, and ask plans which of your high-volume services they removed.
- Get ready for electronic submission: Work with your EHR vendor and revenue cycle team on electronic prior authorization readiness before 2027.
- Watch continuity rules: Confirm that the 90-day transition protections are honored for patients who switch plans.
- Share results: Give your state hospital association examples where plans fall short.
Archive entry for Apr 26, 2026, added Nov. 11, 2026.