Prior Authorization Reform, and What It Doesn't Change

Prior authorization reform has been moving steadily: shorter decision windows, electronic submission requirements, and more transparency about what each payer requires and how often it says no.

This is genuinely good. It is also narrower than the coverage suggests. Reform largely addresses how quickly a payer must answer and how the request is transmitted. It does not reduce what has to be in the request, and it does not remove the requirement itself.

The practices that benefit most from faster decisions are the ones already submitting complete requests. A request that gets a quicker response is only an improvement if the response is an approval. Turnaround rules do nothing for a submission missing the clinical documentation that supports medical necessity.

So the preparation is the same as it always was: know which CPT codes require authorization for which payers, file before the date of service rather than after, and attach the clinical documentation the first time. Reform shortens the wait. It does not fill in the form.