Electronic Prior Authorization Standardized by UNH CVS
Standardizing electronic prior authorization will speed approvals and reduce provider paperwork, a change that may lower payer administrative burdens.
KEY TAKEAWAYS
- UnitedHealthcare and Aetna had standardized electronic prior authorization for more than 50% of volume.
- They targeted more than 70% standardized volume by year-end 2026.
- Cigna had reduced overall medical prior authorization volume by about 15%.
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UnitedHealthcare, Aetna and The Cigna Group announced on April 24, 2026, an industry initiative to standardize electronic prior authorization for commonly reviewed services. The effort aims to speed approvals, support real-time decisions, and reduce provider paperwork while preserving clinical safeguards.
Insurers’ Progress and Regulatory Context
UnitedHealthcare said in a press release that more than half of its prior authorization volume now uses industrywide standardized electronic submission requirements. Aetna reported it has standardized data and submission processes for over 50% of its prior authorizations. Both companies expect to cover more than 70% of their volume under the standard by the end of 2026.
The Cigna Group has implemented standardized electronic prior authorization for commonly reviewed services and targets the same 70% threshold. It also reported a roughly 15% reduction in overall medical prior authorization volume and plans to add services on a rolling basis.
UnitedHealthcare’s rollout spans commercial, Medicare Advantage and Medicaid lines. It will add services and reduce administrative steps over the next several months. The company excludes about 1,500 rural hospitals from the standardized process through fall 2026.
The initiative builds on voluntary industry commitments made to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services in June 2025. It does not change clinical policies or coverage.
A separate CMS final rule effective January 1, 2026, requires seven-day standard and 72-hour expedited decisions for non-drug items and services by payers including Medicare Advantage, Medicaid, CHIP and qualified health plans. CMS has also proposed a rule to extend electronic prior authorization decision timeframes and transparency to drugs and to require HIPAA FHIR standards for prior authorization transactions. That proposal would take effect around 2027 if finalized.
