Getting healthcare should not feel harder because of paperwork. But for many people, prior authorization has added stress, delays, and confusion at exactly the wrong time.
That is why Premera is continuing to make changes to simplify prior authorization and make it faster, clearer, and easier for members and providers to navigate. This work is about protecting access to care while removing unnecessary friction from the process.
These improvements build on a national set of commitments made across Blue Cross and Blue Shield plans and the broader health insurance industry. They also reflect work Premera has already been doing for years to reduce administrative burdens and put members first.
Why prior authorization exists
Prior authorization is used for a limited set of services to help ensure care is appropriate, evidence‑based, and covered by a member’s health plan. It is most often applied to higher‑cost or higher‑risk services, where it can help confirm the right care is delivered in the right setting and avoid unnecessary or duplicative treatments.
At the same time, we recognize that the process has not always worked the way it should. Our focus is on keeping the safeguards that matter while simplifying everything else.
What members are seeing today
Faster decisions
When complete clinical information is submitted, about 85 percent of electronic prior authorization requests are now approved in real time. That means many members and providers can move forward with care without waiting days for an answer.
We are also using technology to speed up approvals. Our in‑house tool, CLARA, which stands for Clinical Logic Automation for Review and Approval, helps identify requests that clearly meet medical criteria so they can be approved more quickly. CLARA is designed to get to yes faster, not to deny care. Any request that is not automatically approved is reviewed by licensed clinicians.
Fewer services that require prior authorization
Premera uses prior authorization selectively and reviews requirements on a regular basis. In 2025, we removed prior authorization for numerous services where it no longer added clinical value, reducing overall case volume by nearly 5,600 requests. That work is ongoing.
Clearer communication
We are working to make prior authorization easier to understand. Notices are written in plain language, explanations are clearer, and next steps are easier to find. Clinical criteria and requirements are publicly available and searchable, so members and providers know what is needed up front.
When questions come up, members can contact customer service teams who are connected directly to clinical staff and can help explain decisions or what information is needed.
Continuity of care when plans change
If a member changes health plans, prior authorizations are honored for 90 days as long as the service is covered and provided in network. This helps prevent disruptions in treatment during transitions and gives members time to focus on their care instead of paperwork
Technology with oversight and accountability
Technology plays an important role in making prior authorization faster and more consistent, but it does not replace clinical judgment. Licensed clinicians review any request that requires additional evaluation using evidence‑based medical policies and national standards. Automated tools are regularly audited and monitored to ensure accuracy, fairness, and accountability.
Our commitment going forward
Even before joining the national prior authorization pledge in 2025, Premera was already working to reduce unnecessary requirements, speed up decisions, and improve communication. We are committed to continuing that work, measuring our progress, and being transparent about what is changing.
Healthcare is complicated enough. Prior authorization should not make it harder than it needs to be. Our focus is on helping members get the care they need, with fewer delays, clearer answers, and less frustration along the way.
Read more about the ongoing efforts by Blue Cross Blue Shield companies to speed up and streamline prior authorizations: https://www.bcbs.com/StreamlinedCare.
