June 23, 2025
Contact: Erin Hemlin, APG Vice President of Communications
ehemlin@apg.org; Tel: (202) 770-1901
WASHINGTON — America’s patients, physician groups, and other key health care stakeholders all stand to benefit from health insurers’ newly released pledge to improve prior authorization, America’s Physician Groups (APG) said today. APG’s statement followed the announced commitment by America’s Health Insurance Plans (AHIP) on behalf of 48 health insurers to undertake a range of measures to shore up confidence in this vitally important mechanism to help manage the provision of health care.
“Prior authorization is an essential tool for weeding out low-value or no-value health care, including unnecessary care that can be harmful to patients,” said Susan Dentzer, APG’s president and chief executive officer. “But as with all tools, it must be used carefully and judiciously, with reasonable timelines and with the rationale for prior authorization decisions made abundantly clear to patients. Because many of our physician groups also undertake prior authorization in the close partnerships they have with health plans, we all have a stake in doing it better and getting it right.”
For example, in APG’s recently released report, Medicare Done Right, APG called for speeding up the transition to electronic prior authorization; increasing transparency and standardization across plans to minimize excessive burden on providers; and increasing the quality and timeliness of communications from both plans and providers with patients to address requests and denials. Similarly, in response to a recent request for information from the Centers for Medicare & Medicaid Services (CMS), APG reiterated a recommendation that CMS establish a uniform, national set of standard prior authorization denial codes and require all payers to use them.
In today’s announcement, health insurers committed to implementing a range of new practices over two years, with the goal of having them fully operational by January 1, 2027. APG looks forward to working with its health plan partners as these changes are put in place – and to improving the experience for all health care stakeholders while delivering care that is truly accountable for costs and quality.
About America’s Physician Groups
APG’s approximately 340 physician groups comprise nearly 200,00 physicians and other clinicians providing care to nearly 90 million patients, including about 1 in 3 Americans and 1 in 3 Medicare Advantage enrollees. APG’s motto, ‘Taking Responsibility for America’s Health,’ represents our members’ commitment to clinically integrated, coordinated, value-based health care in which physician groups are accountable for the costs and quality of patient care. Visit us at www.apg.org.
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