In 2025, insurers committed to scaling back and simplifying prior authorization as they fall into line with standards established by the 2024 Interoperability and Prior Authorization and Medicare Advantage final rules.
But recent aggregated data on prior authorization — which insurers now have to report, thanks to the 2024 regulation — lacks relevant context. For example, insurers do not have to share the number of prior authorization requests for each metric, and they only need to report median and average response times. With 2025 data now live, these reports paint an incomplete portrait of the prior authorization landscape.
As outlined in the insurers’ 2025 pledge, many implementation goals were set to begin in 2026. Separate from last year’s limited intel, it may still be too early to see the effects of insurers’ own prior authorization reforms in 2026, as well.
Harpreet Cheema, Chicago-based CommonSpirit Health’s senior vice president of payer strategy, relationships and analytics, said data for early 2026 remains limited. However, the system is taking steps toward getting on the same page as insurers.
“We are defining some tangible commitments that folks can deliver, which are basically measurable operational outcomes,” he told Becker’s. “We have actually offered to all the health plans to partner with us to demonstrate a project.”
While the regulations set some parameters for insurers, including deadlines of seven days for standard prior authorization requests and 72 hours for expedited ones, health systems may have their own objectives.
CommonSpirit set five targets for insurer partners to meet: at least a 50% reduction in total prior authorization volume, at least 80% real-time authorization decisions, at least a 95% first-pass claims payment rate, reduced technical denials via bidirectional data flow and accounts receivable aging capped at no more than 90 days. Mr. Cheema said the metrics grew out of C-suite-level dialogue across organizations.
He added that the reduction goal for prior authorization volume should apply to overall volume, not just specific categories. For technical denials, such as missing codes, Mr. Cheema also said CommonSpirit is working on its legacy systems and Epic implementation, specifically its enablement of Epic Payer Platform. A bidirectional data flow can help identify missing codes or eligibility information, Mr. Cheema said.
Mr. Cheema’s conversation with Becker’s came shortly before Epic’s real-time prior authorization launch for Ochsner Health in New Orleans, Froedtert ThedaCare Health in Menomonee Falls, Wis., Denver Health and Summit Health in New Providence, N.J. UnitedHealthcare, Network Health and Aetna are involved as insurers. Epic said its effort aims to bolster CMS’ electronic prior authorization priority.
“We definitely welcome that,” Mr. Cheema said of CMS’ electronic prior authorization push from May.
After discussing CommonSpirit’s metrics and goals with prior authorization, Mr. Cheema said the response from health plans has been “uneven.”
“Some are expressing concerns around lack of resources, manpower, stuff like that,” he said. “Hence, it’s ongoing.”
However, Mr. Cheema said CommonSpirit and Humana took a significant step with bidirectional data exchange in a national contract.
Mr. Cheema said he foresees a gradual move toward metric and goal standardization across providers and health plans but acknowledged how different organizations may have unique needs.
“I would say the evolution of this for the next 18 to 36 months is going to be a lot of variation amongst providers and health plans trying to make these initiatives work, but eventually, after that, there will be a move toward making it uniform,” he said. “It will not happen right away.”
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
