JAG INSIGHTS
Stay ahead of billing changes.
Practical updates to help your organization navigate reimbursement, payer policies and revenue cycle operations.
Check back here to stay up-to-date on all billing updates that may apply to your business operations.
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July 22, 2025 — Louisville, KY
Humana has announced a major step toward reducing administrative burden by eliminating a significant portion of its prior authorization requirements for outpatient services by January 1, 2026.Key Changes Coming in 2026
Humana’s plan includes:
Eliminating one-third of prior authorizations for outpatient services, including colonoscopies, transthoracic echocardiograms, and select CT and MRI imaging.
Faster turnaround times: at least 95% of complete electronic prior authorization requests will receive a decision within one business day.
Transparency measures: prior authorization metrics (approvals, denials, and appeals) will be made publicly available.
Technology integration: expanded use of electronic health record (EHR) systems to streamline interoperability and reduce manual processing.
Shift to electronic submissions: Humana will strongly encourage providers to submit requests electronically instead of by fax or phone.
Gold Card Program
In 2026, Humana will launch a gold card program that waives prior authorization requirements for certain items and services when providers demonstrate consistent adherence to medical criteria and high-quality care delivery.
Policy Alignment
Humana also reaffirmed its support of the Improving Seniors’ Timely Access to Care Act (H.R. 3514), reintroduced in May 2025. This legislation would establish a standardized electronic prior authorization process for Medicare Advantage plans, aiming to improve efficiency and reduce delays in patient care.
Why It Matters
Prior authorization remains one of the most cited administrative challenges in healthcare. By reducing requirements, improving turnaround times, and increasing transparency, Humana’s initiative could help accelerate access to care, reduce provider frustration, and build stronger trust between payers and providers.
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IteJAG Billing is closely monitoring industry-standard code set changes to help our clients stay compliant and up to date. Recent updates, like those published by UnitedHealthcare, reflect changes to CPT, HCPCS, ICD-10, modifiers, and related billing codes.
These updates do not change the intent of current reimbursement policies but may affect how services are billed. Categories impacted include:
Add-On Codes
DME, Orthotics & Prosthetics
Maximum Frequency Limits
Technical/Professional Components
Supply Codes
We encourage clients to review the full update provided by UnitedHealthcare for additional context:
🔗 UHC Reimbursement Policy Update – May 2025For questions or guidance on how these updates may impact your billing, please reach out to your JAG Billing account representative.m description
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August 17, 2023