Modernizing Prior Authorization: Progress on Our Commitments to Members and Providers

Since June of 2025, Centene has focused on translating our commitments to improve prior authorization into tangible changes that make a real difference for our more than 27 million members and their providers. This work is grounded in a simple goal: reduce unnecessary complexity while preserving the safeguards that support appropriate, high-quality care. The result is meaningful progress that is already improving how prior authorization works across our plans. 

Since announcing our commitments, Centene has made measurable progress across several key focus areas: 

• Improving communication: We redesigned prior authorization communications based on direct research with members who had recently experienced a denial or appeal ensuring explanations are clearer, more empathetic, and easier to navigate. 

• Enhancing continuity of care: Building on a strong foundation of existing continuity of care operations and to further support members during plan transitions, we enhanced support to members through updated policies. This enables honoring of prior authorizations from a member’s previous plan for the same service, under the same benefit type, with an in-network provider, for a 90-day transition period. 

• Reducing scope: Centene is removing prior authorization requirements for select codes across multiple lines of business through a structured, multiphase, clinician-led review that evaluates utilization, approval rates, and evidence-based guidelines to keep prior authorization targeted and appropriate. For example, beginning in Q4 2025, changes focused on imaging services are expected to eliminate approximately 300,000 prior authorizations annually across Medicare and Marketplace plans while preserving review for higher risk services. 

• Modernizing processes: We implemented internal improvements including enhanced customer service and clinical team training, provider portal and technical enhancements that help providers understand coverage rules and documentation requirements earlier in the process. 

• Maintaining Human Review: As has always been our process, any denials are reviewed by a licensed medical professional. 

“Centene has been intentionally investing in solutions that make it simpler for providers to work with us and help members access care,” said CEO Sarah London. “The progress we’re making reflects a focus on reducing unnecessary complexity, modernizing our processes, and creating a more predictable and transparent experience for those we serve.” 

While we’re proud of the progress made, we know there is more to do. We will continue investing in solutions that support simplified processes, clearer communication and better experiences, collaborating with AHIP and other payers to modernize prior authorization to ensure healthcare is simpler and more accessible for the communities we serve.