Lex Smith

Major US health insurers have standardized data and submission requirements for >50% of prior authorizations, targeting less paperwork for patients and doctors.
One insurer expects >70% of prior authorization requests to use the standardized process by year-end across commercial plans and government-backed businesses combined.
Another major insurer has already standardized ~90% of its prior authorization volume, signaling broader industry progress on simpler, clearer approval steps overall.
The standardized approach covers medical services commonly subject to prior authorization, including orthopedic surgeries and imaging services like CT scans and MRIs.
Health plans aim to improve predictability, reduce rework, cut extra information requests, expand services, and keep coverage rules unchanged for patients and doctors.

US Health Insurers Standardize Prior Authorizations

Health benefits can help small businesses attract and keep strong employees, especially as rising healthcare costs pressure budgets and many smaller employers lag larger firms.
A 2025 survey found 97% of large firms offered health benefits, versus ~59% of small businesses, leaving smaller employers at a recruiting disadvantage.
Cost-conscious options included multiple plan choices, HSAs with high-deductible coverage, and regularly shopping renewals to negotiate better rates or stronger benefits.
Alternatives to traditional group coverage included HRAs for reimbursements and level-funded plans, which offered predictable costs and possible year-end refunds when claims stayed low.
PEOs helped small employers access larger risk pools, better rates, broader coverage, and less benefits administration by handling compliance, onboarding, and claims support.
Wellness programs and compliance support also mattered: screenings, exercise, mental health, and smoking cessation could cut workplac