Aetna announced it has standardized 88% of its prior authorization volume, exceeding industry commitments, while continuing to maintain the fewest medical services requiring prior authorization among national health plans. The company reported that 95%+ of eligible prior authorizations are approved within 24 hours, with 83% processed in real time, exceeding the American Health Insurance Plans’ 2027 industry commitment of 80%. Through automation and digital tools, Aetna has eliminated more than 1 million provider calls.
Aetna is redefining prior authorization by becoming the first national payer to integrate medical and pharmacy decisions into single, condition-specific reviews. Newly launched bundled prior authorization programs, including a comprehensive musculoskeletal offering, build on earlier cancer bundles and create a more seamless experience for patients and providers. According to Aetna President Steve Nelson, “Prior authorization should enable care, not delay it. We’re modernizing the process with speed, transparency, and clinical judgment to benefit everyone we serve.”
The initiatives reflect Aetna’s broader commitment to improving access to care. The company serves an estimated 37 million people with information and resources to help them make better informed healthcare decisions. Aetna offers a broad range of health insurance products and related services, including medical, pharmacy, dental, and behavioral health plans, Medicaid health care management services, workers’ compensation administrative services, and health information technology products. The company emphasizes that its integrated model uses personalized, technology-driven services to connect people to better health, increasing access to quality care, delivering better outcomes, and lowering overall costs.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://menafn.com/1111027526/Aetna-Announces-Progress-On-Industry-Leading-Efforts-To-Simplify-Prior-Authorization