Starting Jan. 1, over 50 insurers will use one data-submission standard for common pre-treatment reviews to cut delays from incomplete documentation.
The aligned requirements cover frequent services like orthopedic surgeries, CT scans, and MRIs across commercial insurance, Medicare, and Medicaid.
Insurers call the framework a key step toward immediate electronic prior authorization responses, following earlier efforts that reduced prior authorizations by 11%.
Participating insurers represent over 250 million covered lives, including many major carriers.
Standardized submissions should simplify provider workflows, boost first-pass approvals, and speed care when needed information arrives.
