Humana Moves To Cut Prior Authorization Delays, Streamline Care Approvals

Core Insights - Humana Inc. is accelerating efforts to streamline prior authorization processes to enhance care request approvals and reduce administrative burdens for physicians [1][3] - The company aims to improve the healthcare system's complexity and navigation challenges as highlighted by its CEO [2] Group 1: Prior Authorization Reforms - Humana plans to reduce prior authorization requirements by approximately one-third for outpatient services by January 1, 2026 [6] - The company will eliminate authorization requirements for specific diagnostic services, including colonoscopies and certain imaging tests [6] - By 2026, Humana aims to provide decisions within one business day for at least 95% of complete electronic prior authorization requests, improving from over 85% currently [6] Group 2: Transparency and Reporting - Starting in 2026, Humana will publicly report prior authorization metrics, including approval and denial rates, as well as average decision times [3] - The company is working to expedite the implementation of new federal transparency requirements related to prior authorization [3] Group 3: Legal and Financial Implications - A recent court ruling upheld the government's decision to downgrade Humana's Medicare quality ratings, which may impact future Medicare bonus payments starting in 2026 [4] - Despite a reported decline in Humana's denial rates, the overall industry has experienced higher rejection rates [4] Group 4: Stock Performance - Humana's stock price increased by 3.18% to $230.53, although it is trading near its 52-week low of $206.87 [5]