Acentra Health applauds the steps taken by private health insurance leaders, the U.S. Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid Services (CMS) leadership to collaborate on accelerating care decisions and enhancing transparency around the prior authorization (PA) process. As this process with private insurers moves forward, we welcome the opportunity to contribute to this national discussion with our perspectives and highlight the work we are doing on behalf of our clients.
As a trusted partner to state and federal health programs across the country, Acentra Health is dedicated to improving the beneficiary and provider experience with an approach that is grounded in thoughtful design, transparency, and a focus on access to care. As such, we remain deeply committed to advancing PA practices that optimize clinical value, reduce administrative burden, and promote timely access to care for members. Our mission is rooted in helping our clients execute their policies while fostering a transparent, efficient, and equitable utilization management (UM) process.
Commitment to Reducing Administrative Burden
We recognize the importance of ensuring that the PA process supports — rather than hinders — access to necessary services. Acentra Health continues to work closely with our state and federal clients to evaluate PA requirements and identify opportunities to eliminate or streamline review of procedures that consistently receive high approval rates. This data-driven, client-focused strategy has been a priority area for us and will remain central to our UM evolution.
Aligning with CMS Interoperability and Access Rules
The final CMS rule (CMS-0057-F) underscores the need for electronic PA tools that improve data exchange and transparency. Acentra Health has been actively engaged in developing application programming interfaces (APIs) for PA, patient access, and provider access — all slated for implementation by January 1, 2027. We are proud to work alongside Leavitt Partners and other leading advisors to build these capabilities to support state readiness and long-term sustainability. These tools will help states reduce administrative burden, improve care coordination, and enhance the member experience by streamlining access to critical health data and automating PA workflows.
Strategic Enhancements in the PA Experience
In alignment with industry best practices and federal guidance, Acentra Health has already launched or is advancing the following initiatives:
- Provider-Friendly Submission Tools
Developing an intuitive submission “wizard” within our Provider Portal designed to guide providers through the PA process with clarity and efficiency
- Transparent and Timely Decisions
Ensuring all decision letters clearly communicate outcomes and appeal options, aligned with the January 1, 2026, CMS deadline
- Criteria Transparency
Making clinical review criteria easily accessible via our public website and Provider Portal, increasing trust and accountability in decision making
- Compliance with Timeliness Standards
Meeting or exceeding CMS-required turnaround times of 72 hours for urgent PA requests and seven calendar days for standard PA requests
- Ongoing Value Assessments
Evaluating PA requirements through regular data analysis and quality review and sharing findings in annual and ad hoc reports
Looking Ahead
Acentra Health stands with the payers, providers, policymakers, and patients who publicly pledged their commitment on June 23, 2025, to build a more responsive, intelligent, and compassionate healthcare system. We are inspired by their passion and view their declaration as a shared call to action. We welcome continued dialogue with our clients and partners.
