Humana to reduce prior authorizations for outpatient services

Humana will eliminate a third of prior authorizations for outpatient services by 2026, the insurer announced Tuesday. Specifically, Humana plans to remove the authorization requirement for diagnostic services across colonoscopies and transthoracic echocardiograms and select MRIs and CT scans.

The changes will go into effect by Jan. 1, 2026, building upon previous efforts to streamline the prior authorization process, which has long faced scrutiny due to the administrative burden it puts on physicians.

In June 2025, dozens of U.S. health plans, Humana included, voluntarily committed to six actions to improve the prior authorization process. The health plans vowed to provide clearer explanations of prior authorization determinations, ensure that at least 80% of electronic prior authorization approvals will be answered in real time and deliver demonstrated reductions to medical prior authorization.

Humana's latest announcement aligns with these commitments. In addition to reducing prior authorization requirements for outpatient services, the insurer will begin providing a decision within one business day for at least 95% of all complete electronic prior authorization requests by Jan. 1, 2026. Currently, Humana provides these decisions within one business day for 85% of outpatient procedures.

"These actions will reduce the number of prior authorization requirements and make the process faster and more seamless, while preserving the system of checks and balances that protects patient safety by ensuring the most high-cost, high-risk treatments are reviewed and approved before care is delivered," the announcement said.

Humana also announced the creation of a national gold card program for physicians. Providers who have a proven record of submitting coverage requests that meet medical criteria will be eligible for the gold card program, which will waive prior authorization requirements for select services.

Additionally, Humana announced plans to publicly report its prior authorization metrics in 2026, in line with the CMS Interoperability and Prior Authorization Final Rule. The rule requires covered payers to increase transparency and data sharing and adopt technologies to improve the prior authorization process. Many of the rule's provisions go into effect on Jan. 1, 2026.

"Today's healthcare system is too complex, frustrating, and difficult to navigate, and we must do better," said Jim Rechtin, president and CEO of Humana.

"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."

Jill McKeon has covered healthcare cybersecurity and privacy news since 2021.