Industry Progress on Prior Authorization: A Shared Commitment

At Centene, we believe accessing healthcare should be simpler and we are committed to doing our part to improve member and provider experiences.

While prior authorization serves a critical function in aligning member care with clinical standards, there is no shortage of challenges our members and providers face when navigating the process.

This is why we are partnering with AHIP (America’s Health Insurance Plans) and other health insurance companies to improve prior authorization for the people we collectively serve. By coming together as an industry, we can make more meaningful progress faster for more Americans.

Together, we’ve highlighted focus areas that reflect our shared responsibility and commitment to delivering continued meaningful impacts by:

• Standardizing Electronic Prior Authorization
• Reducing the Scope of Claims Subject to Prior Authorization
• Ensuring Continuity of Care When Patients Change Plans
• Enhancing Communication and Transparency on Determinations
• Expanding Real-Time Responses
• Ensuring Medical Review of Non-Approved Requests

“AHIP’s recent announcement reinforces what we at Centene have always stood for: leading with transparency and trust, fostering collaboration with our provider partners, and putting the needs of our members first,” said CEO Sarah London. “True healthcare transformation is hard – but we can move faster when we work together as an industry.”

While there’s still work to do to make healthcare work better, this collective commitment is a step in the right direction and reflects Centene’s broader efforts to embrace a more digital, efficient future and improve how care is delivered and experienced.

We’re proud to continue driving this work forward together.