On June 23, 2025, more than 50 health insurers, coordinated by AHIP and the Blue Cross Blue Shield Association, signed a set of commitments to reform prior authorization. By January 1, 2026 they would reduce the scope of services requiring authorization, honor existing authorizations for 90 days when a patient changed plans, and give clearer denial explanations. By January 1, 2027 they would implement a standardized electronic authorization process and return 80 percent of electronic approvals in real time. Physician groups were polite and skeptical; previous industry statements in 2018 and 2023 had produced little that physicians could see.
One year later, we have the first numbers. In April, AHIP and BCBSA reported that participating plans had removed about 11 percent of prior authorization requirements, roughly 6.5 million authorizations a year, and had expanded continuity-of-care protections. UnitedHealthcare went further on May 5, announcing that it would eliminate authorization for about 30 percent of the services that still require it by the end of 2026, and on May 29 said it would remove nearly two-thirds of authorization requirements for members under 18 in its commercial and Medicaid plans by year-end. Here is our read on what has and has not reached the practice level.
Key takeaways
- The 11 percent figure is real and industry-reported. In practice logs it shows up as single digits to low teens by request count, and less by staff time.
- The 90-day continuity rule works at the large national payers when someone asks. Front desks rarely know to ask.
- Denial reasons improved at government lines because CMS-0057-F requires them; commercial denials still often say "does not meet criteria."
- The enforceable change is the CMS API deadline on January 1, 2027, not the voluntary 80 percent target.
- Do not cut authorization staff yet. Reassign toward prevention and appeals, and revisit after the 2027 changes have run a quarter.
What changed
| Commitment | What we see in practices |
|---|---|
| Reduce services requiring authorization | Real but uneven. Low-cost items came off lists at several payers; imaging, high-cost drugs and surgery mostly stayed. Volume reductions in the practices we work with are in the single digits to low teens by count |
| 90-day continuity when patients change plans | Working at the large national payers when the practice knows to ask. Front desks rarely know to ask |
| Clearer denial explanations | Better at government lines, where CMS-0057-F requires a specific reason since January 1, 2026. Commercial denials still often say "does not meet criteria" with nothing more |
| Standardized electronic authorization by 2027 | Not yet visible. Portals remain payer-specific. EHR vendors are building for the CMS API deadline, also January 1, 2027 |
| 80 percent real-time electronic approvals by 2027 | Not yet visible |
A worked volume check
Consider a multispecialty practice that submitted 1,480 authorization requests in the first half of 2025 across its top six payers. In the first half of 2026 it submitted 1,335. That is a 9.8 percent drop, close to the industry's 11 percent, and the practice manager could reasonably call the pledge a success. Then break it down.
| Request type | H1 2025 | H1 2026 | Change | Staff minutes per request (typical) |
|---|---|---|---|---|
| Physical therapy visits beyond limit | 310 | 190 | Down 120 | 10 |
| Injections and minor procedures | 260 | 215 | Down 45 | 12 |
| Advanced imaging (MRI, CT) | 520 | 530 | Up 10 | 35 |
| Surgery and site of service | 240 | 250 | Up 10 | 60 |
| Specialty drugs | 150 | 150 | Flat | 45 |
| Total | 1,480 | 1,335 | Down 145 (9.8%) |
In staff time, the drop is 120 requests at 10 minutes and 45 at 12 minutes, about 29 hours over six months, offset by 20 extra imaging and surgery requests at 35 to 60 minutes each, about 16 hours. Net saving: roughly 13 hours in six months, or about half an hour a week. The count fell nearly 10 percent; the workload fell about 2 percent. This is the arithmetic behind every practice manager who says the pledge changed nothing they can feel.
What did not change
The burden. MGMA's 2026 Annual Regulatory Burden Report, released April 9, found that 92 percent of medical groups had hired or reassigned staff to handle prior authorization volume, and 60 percent said at least three employees touch a single request. Nothing in the first year of the pledge moved those numbers in a way practices can feel. An 11 percent cut in the number of services requiring authorization is not an 11 percent cut in staff time, because the services removed were the quick ones.
The denials. Authorization-related denials (CO-197 and its cousins) remain among the top three denial categories in most practices we audit. Some of that is the payer; much of it is the practice, where the scheduler did not check, the authorization expired, or the approved code did not match the billed code. The pledge does nothing about that half.
The payers not in the room. Employer self-funded plans administered by the same insurers were not always included in the commitments, and the AHIP reporting covers fully insured and commercial lines with varying scope. A practice cannot assume that a payer's announcement applies to every plan with that payer's name on the card.
The regulatory floor underneath
The voluntary pledge sits on top of a rule. CMS-0057-F requires Medicare Advantage, Medicaid managed care and Exchange plans to decide standard requests in seven days and urgent ones in 72 hours, to give specific denial reasons, and to publish annual authorization metrics, all since January 1, 2026, with the electronic prior authorization API due January 1, 2027. Medicare itself has moved the other way in a narrow band: the WISeR model, running since January in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, adds prior authorization to a short list of traditional Medicare services (skin substitutes, certain electrical nerve stimulator implants, knee arthroscopy for knee osteoarthritis, among others) using technology vendors and clinical review. Practices in those six states have a new authorization workflow this year that did not exist before, pledge or no pledge.
What to do with the anniversary
- Re-pull your authorization volume by payer and code for the first half of 2026 and compare it to the first half of 2025, by request type and by staff minutes, as in the table above. If a payer that announced cuts shows no change in your data, ask your provider representative which lists changed and when.
- Teach the desk the 90-day continuity rule. When a patient changes plans mid-treatment, the new plan should honor the existing authorization for 90 days. Write it into the new-insurance workflow.
- Capture the denial reason as a field, not free text, and report it by payer. Where a covered payer gives no specific reason, cite the rule in the appeal.
- Ask your EHR vendor, in writing, whether they will support the FHIR prior authorization API for Medicare Advantage and Medicaid plans by January 1, 2027, and which payers they are testing with.
- Keep the screenshots. Portal responses saying no authorization is required, dated, have overturned more CO-197 denials than any clinical argument.
Our opinion
We think the pledge is better than nothing and worse than a rule. The 11 percent figure is the industry's own number for its own commitments, and the largest single change came from one insurer's own announcements rather than from the pledge itself. The part of 2027 most likely to matter is not the voluntary 80 percent target; it is the CMS API deadline, because it is enforceable and because it forces the EHR vendors to build. Plan around the rule and treat the pledge as upside.
Our denial management service tracks authorization denials by payer, reason and outcome, and the front-office training covers the continuity-of-care conversation. Rates are on the pricing page.
Questions we hear
Has any payer published its list of removed codes?
Most of the large payers have posted code lists by plan type on their provider sites, with effective dates, and UnitedHealthcare's May announcements will produce more through the rest of the year. Save each version with its date; the lists change, and the version in force on the date of service is what an appeal needs.
Should we reduce authorization staff?
Not yet, in our view. Reassign time toward denial prevention and appeals, and revisit staffing after the January 2027 changes have been live for a quarter.
Does the pediatric announcement help a family practice?
Some. UnitedHealthcare named diagnostic imaging, sleep studies, routine outpatient testing and some surgical and therapeutic procedures for members under 18 in commercial and Medicaid plans. A family practice that refers children for those services should see fewer requests once the code lists post; a practice that mostly requests adult imaging will not notice.
What to do this month
- Build the six-month request comparison by type and staff minutes.
- Add the 90-day continuity check to the new-insurance script at the desk.
- Make the stated denial reason a required field in the denial log.
- Send the API question to your EHR vendor and file the answer.
- If you practice in a WISeR state, confirm the affected services are flagged in scheduling.
