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In 2025, insurers committed to scaling back and simplifying prior authorization as they fall into line with standards established by the 2024 Interoperability and Prior Authorization and Medicare Advantage final rules. Now, Chicago-based CommonSpirit Health has laid out concrete CommonSpirit prior authorization targets to measure whether that promised reform is actually materializing.
Why the Reported Data Doesn’t Fully Capture CommonSpirit Prior Authorization Targets Progress
Recent aggregated data on prior authorization, which insurers now have to report thanks to the 2024 regulation, lacks relevant context. Insurers do not have to share the number of prior authorization requests for each metric, and they only need to report median and average response times, leaving 2025 data reports painting an incomplete portrait of the prior authorization landscape.
Why It May Still Be Too Early to See Results
As outlined in insurers’ 2025 pledge, many implementation goals were set to begin in 2026. Separate from last year’s limited intel, it may still be too early to see the effects of insurers’ own prior authorization reforms this year as well. Harpreet Cheema, CommonSpirit’s senior vice president of payer strategy, relationships and analytics, said data for early 2026 remains limited.
The Five CommonSpirit Prior Authorization Targets
“We are defining some tangible commitments that folks can deliver, which are basically measurable operational outcomes,” Cheema told Becker’s. “We have actually offered to all the health plans to partner with us to demonstrate a project.” While federal regulations set some parameters for insurers, including deadlines of seven days for standard prior authorization requests and 72 hours for expedited ones, CommonSpirit set five specific targets: at least a 50% reduction in total prior authorization volume, at least 80% real-time authorization decisions, at least a 95% first-pass claims payment rate, reduced technical denials via bidirectional data flow, and accounts receivable aging capped at no more than 90 days.
Why Volume Reduction Must Apply Broadly
Cheema said the metrics grew out of C-suite-level dialogue across organizations, and he added that the reduction goal for prior authorization volume should apply to overall volume, not just specific categories, a distinction meant to prevent insurers from claiming progress by narrowly targeting easier-to-reduce categories while leaving the bulk of volume unchanged.
How CommonSpirit Is Addressing Technical Denials Within These Prior Authorization Targets
For technical denials, such as missing codes, Cheema said CommonSpirit is working on its legacy systems and Epic implementation, specifically its enablement of Epic Payer Platform. A bidirectional data flow can help identify missing codes or eligibility information, he said.
How This Connects to Epic’s Broader Real-Time Prior Authorization Push
Cheema’s conversation with Becker’s came shortly before Epic’s real-time prior authorization launch for Ochsner Health in New Orleans, Froedtert ThedaCare Health in Menomonee Falls, Wis., Denver Health and Summit Health in New Providence, N.J., with UnitedHealthcare, Network Health and Aetna involved as insurers. Epic said its effort aims to bolster CMS’s electronic prior authorization priority. “We definitely welcome that,” Cheema said of CMS’s electronic prior authorization push from May.
The Uneven Response to These CommonSpirit Prior Authorization Targets
After discussing CommonSpirit’s metrics and goals with prior authorization, Cheema said the response from health plans has been “uneven.” “Some are expressing concerns around lack of resources, manpower, stuff like that,” he said. “Hence, it’s ongoing.”
The Humana Milestone Within This Broader Push
However, Cheema said CommonSpirit and Humana took a significant step with bidirectional data exchange in a national contract, offering a concrete example of at least one major insurer moving forward on the kind of technical data-sharing infrastructure CommonSpirit’s targets call for.
What Cheema Foresees for Prior Authorization Standardization
Cheema said he foresees a gradual move toward metric and goal standardization across providers and health plans but acknowledged how different organizations may have unique needs. “I would say the evolution of this for the next 18 to 36 months is going to be a lot of variation amongst providers and health plans trying to make these initiatives work, but eventually, after that, there will be a move toward making it uniform,” he said. “It will not happen right away.”
Why This Timeline Matters for Other Health Systems
Cheema’s 18-to-36-month projection for eventual standardization gives other health systems watching CommonSpirit’s approach a rough benchmark for how long this transitional period of “variation” is likely to persist before prior authorization metrics and goals converge more broadly across the industry.
What These CommonSpirit Prior Authorization Targets Mean Going Forward
With CommonSpirit’s five specific targets now publicly defined and the Humana bidirectional data exchange serving as an early proof point, other health systems evaluating their own payer relationships may find these metrics, particularly the 50% volume reduction and 95% first-pass claims payment rate, useful benchmarks for their own prior authorization reform conversations. Given Cheema’s characterization of health plan responses as “uneven” due to resource and staffing concerns, the pace of measurable progress toward these targets will likely vary significantly across CommonSpirit’s insurer partners.
What to Watch Going Forward
As more 2026 data becomes available and Epic’s real-time prior authorization capabilities expand beyond its initial four health systems, industry observers will likely watch whether other providers adopt similar concrete, measurable targets rather than relying on insurers’ broader 2025 pledge commitments alone. Given Cheema’s 18-to-36-month timeline for eventual standardization, these CommonSpirit prior authorization targets may serve as an early model that other health systems reference as the industry works toward more uniform prior authorization reform metrics nationwide.
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