Today, AHIP (formerly America’s Health Insurance Plans) and Blue Cross Blue Shield Association announced a new, voluntary effort by leading health plans to make prior authorization easier and more consistent. The initiative is designed to help care teams know exactly what information is needed the first time they submit requests for common services like hip replacement, knee replacement, and CT scans. Blue Shield of California is one of more than 50 participating plans and will make these changes beginning January 1, 2027.
“Patients can experience unnecessary delays in care simply because requirements aren’t always made clear up front,” said Frank Caporusso, senior vice president of Healthcare Quality and Affordability Operations at Blue Shield of California. “This commitment helps set clearer, more consistent expectations so providers can submit the right information the first time, and patients can get the care they need more quickly.”
The announcement builds on recent industry progress.
Earlier this month, AHIP and Blue Shield of California shared new data showing that health plans across the country are reducing how often prior authorization is required, resulting in 6.5 million fewer requests nationwide and faster access to care. This latest step focuses on improving the experience for the remaining prior authorizations that are still clinically appropriate.
“This commitment shows that the industry is serious about how prior authorization affects people’s care experience,” Caporusso said. “The work ahead is about making the process clearer and more dependable for patients and providers.”
The AHIP announcement aligns with Blue Shield of California’s broader Prior Authorization Reimagined effort, launched in 2024, to modernize the prior authorization process, increase real-time and automated decisions, and make expectations clearer and more predictable for care teams.
For more information about Blue Shield of California’s work to simplify prior authorization, visit our Prior Authorization Reimagined page.