Premera Commits to Prior Authorization Improvements

Premera and other Blue Cross and Blue Shield (BCBS) companies are making big changes to simplify the process of getting care approved. These new commitments, announced June 23, 2025, are about putting members first and making healthcare easier, faster, and less frustrating.

Prior authorization is a tool that helps ensure treatments are evidence-based and appropriate, while protecting members from unnecessary costs. But we also know the process can be frustrating. That’s why we’re taking action to improve it.

These are the commitments we’re making:

• Streamlining the process with modern technology
  We’re building a faster, more transparent digital system for prior authorization. By using national data standards, we’ll make it easier for you to submit requests and get faster responses.

• Reducing how often prior authorization is required
  We’re cutting back on the number of in-network services that require prior authorization, especially when providers have a strong track record of appropriate care. These changes will be in place by 2026.

• Protecting care during plan changes
  Starting in 2026, if members switch insurance plans while receiving treatment, we’ll honor your previous approval for up to 90 days, so they can stay on track without delays.

• Making the process more transparent
  We’ll use plain language when explaining decisions, so members know exactly what was approved, what wasn’t, and what to do next. If a service isn’t approved, we’ll connect members with trained support staff who can explain what’s needed, help them understand next steps, and guide them through the appeal process.

• Reviewing all denials with a human in the loop
  Every denial based on clinical reasons will always be reviewed by a licensed medical professional, not just a system.

• Fast-tracking responses
  By 2027, at least 80% of electronic prior authorization requests (submitted with all needed documentation) will be answered in real time across all types of health plans.

These changes reflect our commitment to simplify healthcare and reduce barriers to care, so you can focus on your patients’ health, not paperwork. We’ll measure and report progress to keep ourselves accountable.