Commercial insurer prior authorization rules remain highly fragmented, study shows

A new analysis confirms that despite public pledges to streamline the process, prior authorization requirements from major commercial insurers remain complex and inconsistent. The study found wide variation in the services requiring PA, the clinical criteria used, and the documentation demanded across payers and even across different plans from the same payer. This fragmentation forces practices to maintain payer-specific workflows and creates a high administrative burden. The report underscores that insurer-led reforms have not yet resulted in operational simplification for providers. While some payers have removed PA for certain services, the overall landscape is still a patchwork that complicates revenue cycle management and delays care.