Humana Inc. NYSE: HUM) on Tuesday announced accelerated efforts to approve care requests as quickly as possible and reduce the administrative burden for physicians associated with prior authorization.
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.
“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.
Also Read: Humana Backs Reforms To Limit Medicare Advantage Billing Practices
Humana is working to reduce the red tape on prior authorization in several ways:
- By January 1, 2026, Humana will eliminate approximately one-third of prior authorizations for outpatient services. It will also remove the authorization requirement for diagnostic services, including colonoscopies, transthoracic echocardiograms, and select CT scans and MRIs.
- By January 1, 2026, Humana will provide a decision within one business day on at least 95% of all complete electronic prior authorization requests, expediting care decisions and helping beneficiaries get the right care in a timely manner. Currently, Humana provides a decision within one business day on more than 85% of outpatient procedures.
- In 2026, Humana will launch 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 and delivering high-quality health care with consistent outcomes for Humana members.
In 2026, Humana will report publicly its prior authorization metrics – including prior authorization requests approved, denied, and approved after appeal, and average time between submission and decision. Humana is working to expedite implementation of the new federal transparency requirements.
Last week, a Texas district court dismissed Humana’s lawsuit, upholding the government’s decision to downgrade the company’s Medicare quality ratings. The ruling is expected to reduce Humana’s Medicare bonus payments beginning in 2026, posing a risk to future profitability.
Humana’s denial rates reportedly declined in the last two years of the study period, but the industry saw higher rejection rates.
HUM Price Action: Humana shares were up 3.18% at $230.53 on Tuesday, according to Benzinga Pro.The stock is trading near its 52-week low of $206.87.
Read Next:
Photo by T. Schneider via Shutterstock
