UnitedHealth Group and CVS Health announced on Friday that they have implemented standardized data and submission requirements for more than half of their pre-authorization requests, aiming to reduce wait times and paperwork burdens for patients and physicians.
The healthcare industry is accelerating the pace of reform. Pre-authorization is the process by which insurance companies approve medical services or prescription drugs before coverage is provided. For a long time, varying forms and inconsistent standards across different insurers have created heavy administrative burdens for medical practices, often delaying patient treatment while awaiting approval. Under continued pressure from federal regulators, the industry committed to simplifying the process by June 2025, and this recent action represents a significant step in fulfilling that commitment.
Substantial progress has been made. UnitedHealthcare, part of UnitedHealth Group, stated that over half of its pre-authorization requests are now part of a standardized electronic submission system. The company expects this proportion to rise to over 70% by the end of 2026, covering its commercial insurance, Medicare Advantage, and Medicaid plans. Aetna, under CVS Health, has already standardized 88% of its pre-authorization volume, with 83% of those requests processed instantly and over 95% of eligible requests approved within 24 hours.
Early results of the reform are visible. Standardization will unify the information formats required by insurers, aiming to improve predictability of approvals, reduce rework, and decrease requests for additional documentation, without affecting clinical policies or coverage decisions themselves. Through automation, Aetna has already reduced over one million inquiry calls from healthcare providers.
This standardization will primarily apply to services that commonly require pre-authorization, such as orthopedic surgeries and imaging studies like CT and MRI scans. Analysts note that if standards become uniform and response times quicken, physicians could receive approval results during patient consultations, significantly lowering the risk of treatment delays. As other insurers, including Cigna, join the reform efforts, the entire industry is expected to see a notable improvement in approval efficiency.
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